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NPI Code Detail

MEDICARE: DR. MATTHEW JACOBSEN DMD, MD

MEDICARE: DR. MATTHEW JACOBSEN DMD, MD
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
11223S0112XOral and Maxillofacial Surgery (Dentist)4167ME

General Provider Information

NPI Number : 1568453108
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW JACOBSEN DMD, MD
Provider Business Mailing Address
First Line : 20 LONG CREEK DRIVE
Second Line : ORAL SURGERY ASSOCIATES PA
City : SOUTH PORTLAND
State : ME
Zip : 04106
Country : US
Telephone Number : 207-772-3027
Fax Number : 207-772-8641
Provider Business Practice Location Address
First Line : 20 LONG CREEK DR
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-2425
Country : US
Telephone Number : 207-772-3027
Fax Number : 207-772-8641
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 07/02/2015

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