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General NPI Number Information
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NPI Number | 1487897831
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Entity Type | Organization
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Legal Business Name | BLAIN JACOBSON, DMD, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 04/15/2009
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Last Update Date | 04/15/2009
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Provider Practice Location Address
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Address Line | 6910 DOUGLAS BLVD STE A
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City | GRANITE BAY
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State | CA
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Zip | 95746-6276
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Country | US
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Telephone | 916-722-4353
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Fax |
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Provider Business Mailing Address
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Address Line | 6910 DOUGLAS BLVD STE A
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City | GRANITE BAY
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State | CA
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Zip | 95746-6276
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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. BLAIN JACOBSON
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Credential |
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Telephone | 916-772-4353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 56390
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License Number State | CA
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