Healthcare Provider Details

I. General information

NPI: 1346863131
Provider Name (Legal Business Name): JACOB DAWSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5709 NW RADIAL HWY
OMAHA NE
68104-4141
US

IV. Provider business mailing address

400 RIVERWALK TER STE 250
JENKS OK
74037-5619
US

V. Phone/Fax

Practice location:
  • Phone: 402-551-1757
  • Fax: 402-551-4384
Mailing address:
  • Phone: 918-998-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7280
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7759
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: