Individual
JACOB GROOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7012 NE 40TH ST, VANCOUVER, WA 98661-3052
(360) 254-5254
Mailing address
4530 NW WALDEN ST, CAMAS, WA 98607-9130
(503) 702-6532
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE61203036
WA
Other
Enumeration date
06/25/2021
Last updated
04/11/2025
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