| Jacob R Diebold, Dds, Llc | |
|
7181 Us Highway 61 St. Francisville LA 70775 | |
| (225) 635-4707 | |
| (225) 635-2172 |
| Full Name | Jacob R Diebold, Dds, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 7181 Us Highway 61, St. Francisville, Louisiana |
| Authorized Official Name and Position | Jacob Ryan Diebold (MANAGING MEMBER) |
| Authorized Official Contact | 3186143273 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacob R Diebold, Dds, Llc Po Box 1068 Saint Francisville LA 70775-1068 Ph: (225) 635-4707 | Jacob R Diebold, Dds, Llc 7181 Us Highway 61 St. Francisville LA 70775 Ph: (225) 635-4707 |
| NPI Number | 1902286941 |
|---|---|
| Provider Enumeration Date | 06/04/2015 |
| Last Update Date | 06/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902286941 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 6554 (Louisiana) | Primary |