Organization
HPOMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK B JACOB DDS, MS, PC (OWNER)
(847) 433-6636
Entity
Organization
Contact information
Practice address
1893 SHERIDAN RD SUITE 311, HIGHLAND PARK, IL 60035
(847) 433-6636
(847) 433-2090
Mailing address
1893 SHERIDAN RD SUITE 311, HIGHLAND PARK, IL 60035
(847) 433-6636
(847) 433-2090
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
019.022948
IL
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
021.002059
IL
Other
Enumeration date
07/03/2014
Last updated
07/03/2014
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