Healthcare Provider Details

I. General information

NPI: 1235417882
Provider Name (Legal Business Name): JACOB JAMES C ENGLAND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/30/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 683 WAIANAE
SCHOFIELD BARRACKS HI
96786-0001
US

IV. Provider business mailing address

BLDG 9900 LINCOLN STREET 2ND FLOOR
TACOMA WA
98431
US

V. Phone/Fax

Practice location:
  • Phone: 812-760-1879
  • Fax:
Mailing address:
  • Phone: 253-968-4035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number12011670A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: