| NPI | 1366030819 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY JACOBSON Owner 916-877-7450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2024-03-06 |