Individual
DR. RONALD JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
4200 W PETERSON AVE, SUITE 116, CHICAGO, IL 60646-6074
(773) 545-5333
(773) 545-3636
Mailing address
4200 W PETERSON AVE, SUITE 116, CHICAGO, IL 60646-6074
(773) 545-5333
(773) 545-3636
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021001468
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01901183
LICENSE NUMBER
IL
Enumeration date
03/12/2007
Last updated
06/09/2008
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