Individual
DR. TESSIE JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1131 WEST STREET, BUILDING#1 SUITE#5, SOUTHINGTON, CT 06489-6006
(860) 414-6897
Mailing address
1131 WEST STREET, BUILDING#1 SUITE#5, SOUTHINGTON, CT 06489-6006
(860) 414-6897
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
11465
CT
1223G0001X
General Practice Dentistry
Primary
11465
CT
Other
Enumeration date
07/13/2015
Last updated
07/01/2020
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