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1265056121
JACOB TALL
IDAHO FALLS, ID
NPI
1265056121
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
122300000X Dentist
(Licence: ID D-5144)
Enumeration Date
2020-06-05
Last Update Date
2020-06-05
Business Address
JACOB TALL
2460 E 25TH ST
IDAHO FALLS, ID 83404-7549
Phone number: 208-525-4780
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Mailing Address
JACOB TALL
2460 E 25TH ST
IDAHO FALLS, ID 83404-7549
Phone number: 208-525-4780
Copy
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