Individual
KEZIA ANILA JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
159 ALTAMA CONNECTOR, BRUNSWICK, GA 31525
(912) 264-8408
Mailing address
159 ALTAMA CONNECTOR, BRUNSWICK, GA 31525-1853
(540) 239-2943
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
058964
NY
Other
Enumeration date
06/15/2015
Last updated
05/26/2018
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