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Individual

DR. JONATHAN H JACOBS

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
22811 GREATER MACK AVE, STE. L-10, ST CLAIR SHORES, MI 48080-2021
(586) 774-2400
(586) 774-2461
Mailing address
22811 GREATER MACK AVE, STE. L-10, ST CLAIR SHORES, MI 48080-2021
(586) 774-2400
(586) 774-2461

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901012905
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
689419
UNITED CONCORDIA
MI
Enumeration date
03/25/2006
Last updated
07/08/2007
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