MEDICARE: DR. LEONARD JACOBS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN 13570	FL

General Provider Information

NPI Number	:	1043259385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD JACOBS D.D.S.

Provider Business Mailing Address
First Line	:	7301A W PALMETTO PARK RD
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3409
Country	:	US
Telephone Number	:	561-362-8308
Fax Number	:	561-362-7654

Provider Business Practice Location Address
First Line	:	7301A W PALMETTO PARK RD
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3409
Country	:	US
Telephone Number	:	561-362-8308
Fax Number	:	561-362-7654

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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