Provider Demographics
NPI:1770101560
Name:JACOBS, JONKER CASPER (DMD)
Entity type:Individual
Prefix:DR
First Name:JONKER
Middle Name:CASPER
Last Name:JACOBS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1565
Mailing Address - Country:US
Mailing Address - Phone:847-971-4360
Mailing Address - Fax:
Practice Address - Street 1:820 DAVIS ST STE 460
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4447
Practice Address - Country:US
Practice Address - Phone:847-332-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019032784122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist