Provider Demographics
NPI:1427124056
Name:JACOBSMEIER-STRAIT, MARY JO M (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:M
Last Name:JACOBSMEIER-STRAIT
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 1:801 HWY 30 W
Mailing Address - Street 2:P.O. BOX 202
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-0202
Mailing Address - Country:US
Mailing Address - Phone:319-895-8322
Mailing Address - Fax:319-895-8109
Practice Address - Street 1:801 HIGHWAY 30 SW
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-9518
Practice Address - Country:US
Practice Address - Phone:319-895-8322
Practice Address - Fax:319-895-8109
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA79151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1157644Medicaid