Healthcare Provider Details

I. General information

NPI: 1497357198
Provider Name (Legal Business Name): JACOBSON DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W OLIVE AVE
MERCED CA
95348-3134
US

IV. Provider business mailing address

3655 TORRANCE BLVD STE 425
TORRANCE CA
90503-4844
US

V. Phone/Fax

Practice location:
  • Phone: 209-877-5437
  • 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 Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

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