Organization
HIGHLAND PARK OMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK B JACOB DDS, MS (OWNER)
(847) 433-6636
Entity
Organization
Contact information
Practice address
1893 SHERIDAN RD, SUITE 311, HIGHLAND PARK, IL 60035-2628
(847) 433-6636
(847) 433-2090
Mailing address
1893 SHERIDAN RD, SUITE 311, HIGHLAND PARK, IL 60035
(847) 433-6636
(847) 433-2090
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
019022948
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
021002059
IL
Other
Enumeration date
10/25/2011
Last updated
10/25/2011
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