Individual
DR. BRIAN R JAKUSZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
N95W25901 CTY HWY Q, SUITE I, COLGATE, WI 53017-9225
(262) 628-0555
Mailing address
N95W25901 CTY HWY Q, SUITE I, COLGATE, WI 53017-9225
(262) 628-0555
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5492015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33793900
—
WI
Enumeration date
11/22/2006
Last updated
04/29/2011
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