Jacob Tall

NPI #1265056121 in Idaho Falls, Idaho

Provider Information

NPI Number
1265056121
Entity Type
Individual
Name
Jacob Tall
Gender
Not Specified
Sole Proprietor
Yes
Primary Specialty
Dentist
Enumeration Date
Jun 5, 2020
Last Updated
Jun 5, 2020

Practice Location

Address
2460 E 25TH ST
State
Idaho
ZIP Code
83404-7549
Phone
(208) 525-4780

Specialties & Taxonomy Codes

Specialty
Dentist

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