Organization
JACOBSON ORTHODONTIC ASSOCIATES, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD SCOTT JACOBSON D.D.S., M.S. (PRESIDENT)
(773) 545-5333
Entity
Organization
Contact information
Practice address
4200 W PETERSON AVE, SUITE 116, CHICAGO, IL 60646-6074
(773) 545-5333
(773) 545-3636
Mailing address
4200 W PETERSON AVE, SUITE 116, CHICAGO, IL 60646-6074
(773) 545-5333
(773) 545-3636
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
060.004616
IL
Other
Enumeration date
03/06/2009
Last updated
03/06/2009
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