DANIEL ROBERT JACOBSEN Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019028635

License Status

ACTIVE

Business

First Name

DANIEL

Middle

ROBERT

Last Name

JACOBSEN

Business Name

DANIEL ROBERT JACOBSEN

Original Issue Date

06/07/2011

Effective Date

07/08/2024

Expiration Date

09/30/2027

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Ever Disciplined

LastModifiedDate

07/08/2024