MEDICARE: GILBERT 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
1	1223P0300X	Periodontics	3781	FL

General Provider Information

NPI Number	:	1881608990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILBERT JACOBSON D.D.S

Provider Business Mailing Address
First Line	:	GILBERT JACOBSON D.D,S. PA
Second Line	:	1048 KANE CONCOURSE 2-F
City	:	BAY HARBOR
State	:	FL
Zip	:	33154
Country	:	US
Telephone Number	:	305-865-0328
Fax Number	:	305-865-1746

Provider Business Practice Location Address
First Line	:	GILBERT JACOBSON D.D,S. PA
Second Line	:	1048 KANE CONCOURSE 2-F
City	:	BAY HARBOR
State	:	FL
Zip	:	33154
Country	:	US
Telephone Number	:	305-865-0328
Fax Number	:	305-865-1746

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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