Individual
JACOB T. TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
306 WALNUT AVE STE 26, SAN DIEGO, CA 92103-4980
(619) 299-3320
Mailing address
306 WALNUT AVE STE 26, SAN DIEGO, CA 92103-4980
(619) 299-3320
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
104424
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
A196653
CA
Other
Enumeration date
04/15/2018
Last updated
07/01/2024
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