Individual
DR. JACOB A DENIAKOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
300 S. TWINING STREET, BLDG 760, 42D MEDICAL GROUP, MAXWELL AFB, AL 36112
(334) 953-8607
(334) 953-8607
Mailing address
300 S. TWINING STREET, BLDG 760, 42D MEDICAL GROUP, MAXWELL AFB, AL 36112
(334) 953-5143
(334) 953-8607
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6439
LA
Other
Enumeration date
08/26/2014
Last updated
08/27/2015
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