Provider Demographics
NPI:1790808822
Name:JAKUBOWSKI, PAUL WITOLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WITOLD
Last Name:JAKUBOWSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MOHAWK RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34715-7433
Mailing Address - Country:US
Mailing Address - Phone:352-243-2323
Mailing Address - Fax:352-243-2310
Practice Address - Street 1:260 MOHAWK RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34715-7433
Practice Address - Country:US
Practice Address - Phone:352-243-2323
Practice Address - Fax:352-243-2310
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 141871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice