Individual
DR. JACOB VAUGHN LILJENQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1000 N 8TH AVE, POCATELLO, ID 83201-5757
(208) 232-3368
(208) 776-5016
Mailing address
9435 CASTLE OAKS DR, FOUNTAIN, CO 80817-4517
(702) 426-7558
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7754866-9921
UT
122300000X
Dentist
DE60162914
WA
1223D0001X
Public Health Dentistry
D4811
ID
1223G0001X
General Practice Dentistry
Primary
7754866-9921
UT
Other
Enumeration date
08/20/2010
Last updated
05/17/2019
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