Liljenquist, Jacob Vaughn

Liljenquist, Jacob Vaughn is an individual health care provider with primary practice located at 1000 N 8Th Ave , Pocatello ID 83201-5757. He recently has 3 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Dentist, Dental Providers / Dental Public Health. Dental Providers / General Practice is his primary health care specialty. Liljenquist, Jacob Vaughn can be contacted via phone (208) 232-3368.

Contact Information

Primary practice address
1000 N 8Th Ave Pocatello ID 83201-5757
Phone: (208) 232-3368
Fax: (208) 776-5016
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 7754866-9921 Utah
Dental Providers / Dentist 122300000X 7754866-9921 Utah
Dental Providers / Dentist 122300000X DE60162914 Washington
Dental Providers / Dental Public Health 1223D0001X D4811 Idaho

Profile Details

NPI number 1508172107
LBN Legal business name Liljenquist, Jacob Vaughn
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 20th, 2010
Last updated May 17th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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