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General NPI Number Information
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NPI Number | 1508922428
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Entity Type | Individual
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Provider Name | BARRY T JACOBS DDS
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Gender | Male
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 615 LAKE SHORE DR W
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City | ASHLAND
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State | WI
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Zip | 54806-1507
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Country | US
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Telephone | 715-682-2811
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Fax |
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Provider Business Mailing Address
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Address Line | 615 LAKE SHORE DR W
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City | ASHLAND
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State | WI
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Zip | 54806-1507
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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 |
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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 | 4283-15
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License Number State | WI
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