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General NPI Number Information
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NPI Number | 1205085602
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Entity Type | Organization
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Legal Business Name | JACOBS FAMILY DENTISTRY, PC
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 701 N 4TH ST SUITE 100
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City | ABERDEEN
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State | SD
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Zip | 57401-2727
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Country | US
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Telephone | 605-725-5565
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Fax |
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Provider Business Mailing Address
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Address Line | 701 N 4TH ST SUITE 100
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City | ABERDEEN
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State | SD
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Zip | 57401-2727
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN JACOBS
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Credential |
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Telephone | 605-725-5565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | M952
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License Number State | SD
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