Healthcare Provider Details

I. General information

NPI: 1538278031
Provider Name (Legal Business Name): DAVID SCOTT JACOBSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TOWN COMMON CIR
CAPE ELIZABETH ME
04107-2043
US

IV. Provider business mailing address

200 TOWN COMMON CIR
CAPE ELIZABETH ME
04107-2043
US

V. Phone/Fax

Practice location:
  • Phone: 207-767-3241
  • Fax: 207-767-3242
Mailing address:
  • Phone: 207-767-3241
  • Fax: 207-767-3242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4049
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: