Individual
BLAIN JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
6910 DOUGLAS BLVD STE A, GRANITE BAY, CA 95746-6276
(916) 813-5363
Mailing address
6910 DOUGLAS BLVD STE A, #A, GRANITE BAY, CA 95746-6276
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
56390
CA
Other
Enumeration date
07/09/2008
Last updated
12/18/2008
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