Mack Jacob, DDS Valid NPI

Individual provider · Dentist · Berkeley, CA

NPI

1194845784

Type

Individual (Type 1)

Primary specialty

Dentist

Specialty group

Dental Providers

Taxonomy code

122300000X

License number

38432 (CA)

Sex

Male

Sole proprietor

Yes

Enumerated

2007-03-29

Last updated

2007-07-08