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General NPI Number Information
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NPI Number | 1487914487
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Entity Type | Organization
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Legal Business Name | JACOBSEN & SHAW, DDS, PLLC
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 05/23/2012
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Provider Practice Location Address
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Address Line | 4915 25TH AVE NE SUITE 107
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City | SEATTLE
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State | WA
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Zip | 98105-5667
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Country | US
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Telephone | 206-381-0732
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Fax | 206-381-0513
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Provider Business Mailing Address
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Address Line | 4915 25TH AVE NE SUITE 107
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City | SEATTLE
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State | WA
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Zip | 98105-5667
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Country | US
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Telephone | 206-381-0732
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Fax | 206-381-0513
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. ELIZABETH HEADLEY JACOBSEN
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Credential | DDS
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Telephone | 206-381-0732
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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 | DE60035233
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License Number State | WA
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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 | DE40021232
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License Number State | WA
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