| NPI | 1114143120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | T GREGORY JACOBS President Owner 813-310-9580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2016-01-13 |