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NPI Code Detail

MEDICARE: DR. STEVEN EUGENE JACOBSON D.D.S.

MEDICARE: DR. STEVEN EUGENE JACOBSON 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
11223P0300XPeriodontics52521CA

General Provider Information

NPI Number : 1265760698
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEVEN EUGENE JACOBSON D.D.S.
Provider Business Mailing Address
First Line : 44550 VILLAGE CT
Second Line : SUITE 102
City : PALM DESERT
State : CA
Zip : 92260-3817
Country : US
Telephone Number : 760-674-4410
Fax Number : 760-674-4414
Provider Business Practice Location Address
First Line : 44550 VILLAGE CT
Second Line : SUITE 102
City : PALM DESERT
State : CA
Zip : 92260-3817
Country : US
Telephone Number : 760-674-4410
Fax Number : 760-674-4414
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2009
Last Update Date : 11/23/2009

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