Individual
SHANDA JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
3111 WALL ST, LEXINGTON, KY 40513-9008
(859) 223-1833
Mailing address
103 WINDY VIEW CT, NICHOLASVILLE, KY 40356-8851
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
4047
KY
Other
Enumeration date
06/17/2020
Last updated
06/17/2020
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