Individual
DR. LESLIE J JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
113 RUE FONTAINE, LAFAYETTE, LA 70508
(337) 500-1500
Mailing address
113 RUE FONTAINE, LAFAYETTE, LA 70508
(337) 500-1500
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5189
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
452452184
DENTAL INSURANCES
LA
Enumeration date
02/27/2007
Last updated
11/26/2018
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