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General NPI Number Information
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NPI Number | 1174109789
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Entity Type | Individual
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Provider Name | JACOB DEAN ANDERSEN DMD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 6264 S FM 14
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City | HAWKINS
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State | TX
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Zip | 75765-4844
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Country | US
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Telephone | 903-769-1606
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Fax |
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Provider Business Mailing Address
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Address Line | 6264 S FM 14
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City | HAWKINS
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State | TX
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Zip | 75765-4844
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Country | US
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Telephone | 903-769-1606
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 00000
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5971582
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 38676
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License Number State | TX
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