Healthcare Provider Details

I. General information

NPI: 1275769432
Provider Name (Legal Business Name): JACOB LEE SAXTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 LASKIN RD #100
VIRGINIA BEACH VA
23454-4538
US

IV. Provider business mailing address

1805 LASKIN RD #100
VIRGINIA BEACH VA
23454-4538
US

V. Phone/Fax

Practice location:
  • Phone: 757-321-1870
  • Fax: 757-963-0468
Mailing address:
  • Phone: 757-321-1870
  • Fax: 757-963-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60096175
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401413269
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: