Healthcare Provider Details

I. General information

NPI: 1851217442
Provider Name (Legal Business Name): JACOB JARZYNKA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 S 60TH ST STE B
OMAHA NE
68106-2166
US

IV. Provider business mailing address

1905 N 54TH ST
OMAHA NE
68104-4959
US

V. Phone/Fax

Practice location:
  • Phone: 402-553-7888
  • Fax:
Mailing address:
  • Phone: 402-686-0547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8242
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: