Individual
DR. MILES J JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2838 N OLIVER ST, WICHITA, KS 67220-2983
(316) 978-8350
Mailing address
10437 E FAWN GROVE CT, WICHITA, KS 67207-4364
(316) 644-3298
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
61458
KS
Other
Enumeration date
08/16/2017
Last updated
08/16/2017
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