Healthcare Provider Details

I. General information

NPI: 1710739099
Provider Name (Legal Business Name): JACOB HAMELBURG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142A CANAL ST
SALEM MA
01970-4650
US

IV. Provider business mailing address

267 HUMPHREY ST
SWAMPSCOTT MA
01907-2511
US

V. Phone/Fax

Practice location:
  • Phone: 781-598-3700
  • Fax:
Mailing address:
  • Phone: 781-910-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10001219
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: