Individual
JACOB L REVERCOMB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8076 CAZENOVIA RD, MANLIUS, NY 13104
(315) 682-8400
(315) 682-2602
Mailing address
8076 CAZENOVIA RD, MANLIUS, NY 13104
(315) 682-8400
(315) 682-2602
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
048833
NY
Other
Enumeration date
09/25/2006
Last updated
07/08/2007
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