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NPI Code Detail

MEDICARE: PETER JACOBSEN DDS

MEDICARE: PETER JACOBSEN DDS
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
11223G0001XGeneral Practice Dentistry26765CA

General Provider Information

NPI Number : 1639174923
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER JACOBSEN DDS
Provider Business Mailing Address
First Line : 2383 CALIFORNIA ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-2702
Country : US
Telephone Number : 415-921-2448
Fax Number :
Provider Business Practice Location Address
First Line : 2383 CALIFORNIA ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-2702
Country : US
Telephone Number : 415-921-2448
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 05/01/2013

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Directions to “ PETER JACOBSEN DDS” Practice Location

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