Individual
JACOB JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
4930 E LAKE MARY BLVD, SANFORD, FL 32771-5003
(407) 322-8645
Mailing address
4930 E LAKE MARY BLVD, SANFORD, FL 32771-5003
(407) 322-8645
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
HAD110
FL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
02/15/2016
Last updated
06/21/2021
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