Provider Demographics
NPI:1093806598
Name:JAKUBAS, JOAN MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:MARIE
Last Name:JAKUBAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 HIAWATHA AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3928
Mailing Address - Country:US
Mailing Address - Phone:612-721-3012
Mailing Address - Fax:612-721-5106
Practice Address - Street 1:4721 HIAWATHA AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-3928
Practice Address - Country:US
Practice Address - Phone:612-721-3012
Practice Address - Fax:612-721-5106
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN836516OtherUNITED CONCORDIA
MN012466OtherUCARE
MAZ97489OtherBLUE CROSS BLUE SHIELD MA
MN45616JAOtherBLU CROSS BLUE SHIELD MN