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General NPI Number Information
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NPI Number | 1154946507
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Entity Type | Individual
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Provider Name | JACOB ADKINS DMD
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Gender | Male
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 4032 S COLLEGE AVE # A1
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City | FORT COLLINS
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State | CO
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Zip | 80525-3076
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Country | US
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Telephone | 970-225-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 20707 N 67TH AVE APT 259
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City | GLENDALE
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State | AZ
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Zip | 85308-6691
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Country | US
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Telephone | 925-588-8773
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00204397
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License Number State | CO
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