Individual
JACOB DIEBOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
7181 US HIGHWAY 61, SUITE 10, ST. FRANCISVILLE, LA 70775
(225) 635-4707
(225) 635-2172
Mailing address
PO BOX 1068, SAINT FRANCISVILLE, LA 70775-1068
(225) 635-4707
(225) 635-2172
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6554
LA
Other
Enumeration date
06/23/2015
Last updated
06/23/2015
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