Most Relevant Information
Provider Data
| NPI Number: | 1003544842 |
| Provider Name: | JACOB MACK DMD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/10/2022 |
| Last Updated: | 11/07/2023 |
Provider Practice Location
2355 FACULTY DR
USAF ACADEMY
CO
808401805
Practice Location Phone/Fax
| Phone: | 4158168885 |
| Fax: |
Provider Mailing Location
12570 TOSCANA HTS APT 1322
COLORADO SPRINGS
CO
809215657
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |