DR. Connie Ann Jacobson, D.D.S.

NPI #1114054947 in West Salem, Wisconsin

Provider Information

NPI Number: 1114054947
Entity Type: Individual
Name: DR. Connie Ann Jacobson, D.D.S.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist
Credential: D.D.S.
Enumeration Date: Feb 28, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 1529 HERITAGE BLVD
City: West Salem
State: Wisconsin
ZIP Code: 54669-9404
Phone: (608) 786-0900

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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