Individual
DR. MARK J JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
16824 NEWBURGH RD, LIVONIA, MI 48154-1600
(734) 591-4145
(734) 591-4168
Mailing address
2771 FERRIS ST, BERKLEY, MI 48072-2113
(248) 246-6390
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1388995
MI
Other
Enumeration date
07/30/2006
Last updated
07/08/2007
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