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General NPI Number Information
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NPI Number | 1083934046
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Entity Type | Individual
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Provider Name | DINA JACOBS RDH
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Gender | Female
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 06/01/2010
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Provider Practice Location Address
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Address Line | 3800 S MYRTLE ST
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City | SEATTLE
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State | WA
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Zip | 98118-3529
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Country | US
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Telephone | 206-461-6981
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Fax | 206-461-8581
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Provider Business Mailing Address
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Address Line | 905 SPRUCE ST SUITE 300
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City | SEATTLE
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State | WA
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Zip | 98104-2474
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Country | US
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Telephone | 206-461-6935
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Fax | 206-461-8382
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH00006726
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2665
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License Number State | KS
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