Healthcare Provider Details

I. General information

NPI: 1316972839
Provider Name (Legal Business Name): IRVING W. JACOBSON DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 WELSH RD
PHILADELPHIA PA
19115-4655
US

IV. Provider business mailing address

1916 WELSH RD
PHILADELPHIA PA
19115-4655
US

V. Phone/Fax

Practice location:
  • Phone: 215-676-2311
  • Fax: 215-676-7193
Mailing address:
  • Phone: 215-676-2311
  • Fax: 215-676-7193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS-018061-L
License Number StatePA

VIII. Authorized Official

Name: DR. IRVING JACOBSON
Title or Position: PRES. OWNER
Credential: DMD
Phone: 215-676-2311