Healthcare Provider Details

I. General information

NPI: 1962169433
Provider Name (Legal Business Name): JACOBSON DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 SPRINGFIELD DR STE 110
CHICO CA
95928-6398
US

IV. Provider business mailing address

3655 TORRANCE BLVD STE 425
TORRANCE CA
90503-4844
US

V. Phone/Fax

Practice location:
  • Phone: 530-694-4440
  • Fax: 844-534-8464
Mailing address:
  • Phone: 916-877-7450
  • Fax: 844-534-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY JACOBSON
Title or Position: OWNER
Credential: DMD
Phone: 916-877-7450