ERIC EDWIN JACOBSEN

PHOENIX, AZ
NPI1720241052
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1223P0221X Dentist, Pediatric Dentistry
(Licence: AZ  D7908)
Additional Taxonomies1223P0221X Dentist, Pediatric Dentistry
(Licence: OR  D9115)
Enumeration Date2008-07-07
Last Update Date2009-10-15
Business Address
Dr. ERIC EDWIN JACOBSEN DDS
6750 N 19TH AVE
PHOENIX, AZ 85015-1127
Phone number: 602-242-5741
Mailing Address
Dr. ERIC EDWIN JACOBSEN DDS
22320 N 59TH LN
GLENDALE, AZ 85310-4264
Phone number: 443-562-5564