Individual provider · Type 1 NPI

Jacob Itskovich, DMD

Student in an Organized Health Care Education/Training Program · Farmington, CT

NPI number 1194350140 Active

Practice location

263 Farmington Ave
Farmington, CT 06030-0001

Call (860) 679-2000 Map

Mailing address

6855 Leytonstone Blvd
West Bloomfield, MI 48322-1243

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000X12877 (CT)

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1194350140

Jacob Itskovich, DMD's National Provider Identifier is 1194350140, issued on Mar 10, 2020. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Farmington, CT. The record was last updated on Aug 4, 2020.