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1194350140
JACOB ITSKOVICH
FARMINGTON, CT
NPI
1194350140
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
(Licence: CT 12877)
Enumeration Date
2020-03-10
Last Update Date
2020-08-04
Business Address
JACOB ITSKOVICH DMD
263 FARMINGTON AVE
FARMINGTON, CT 06030-0001
Phone number: 860-679-2000
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Mailing Address
JACOB ITSKOVICH DMD
6855 LEYTONSTONE BLVD
WEST BLOOMFIELD, MI 48322-1243
Phone number: 248-303-5919
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