Organization
JACOB R DIEBOLD, DDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB RYAN DIEBOLD D.D.S (MANAGING MEMBER)
(318) 614-3273
Entity
Organization
Contact information
Practice address
7181 US HIGHWAY 61, ST. FRANCISVILLE, LA 70775
(225) 635-4707
(225) 635-2172
Mailing address
PO BOX 1068, SAINT FRANCISVILLE, LA 70775-1068
(225) 635-4707
(225) 635-2172
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
6554
LA
Other
Enumeration date
06/04/2015
Last updated
06/04/2015
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