Individual
DR. JACOB ALEXANDER FANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
520 N 12TH ST, RICHMOND, VA 23298-5064
(804) 828-7767
Mailing address
12506 MANDOLIN DR, MIDLOTHIAN, VA 23113-2805
(703) 677-4229
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401417475
VA
Other
Enumeration date
06/25/2021
Last updated
06/25/2021
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