Individual
JACOB SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1017 W MADISON ST, CHICAGO, IL 60607-2007
(312) 759-1120
Mailing address
1686 CHARLOTTE CIR, NAPERVILLE, IL 60564-8205
(630) 414-3884
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.032124
IL
Other
Enumeration date
06/06/2019
Last updated
06/06/2019
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