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General NPI Number Information
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NPI Number | 1518457118
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Entity Type | Individual
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Provider Name | CHRISTOPHER L JACOBSEN DMD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 06/20/2022
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Provider Practice Location Address
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Address Line | 5800 STANFORD RANCH RD STE 510
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City | ROCKLIN
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State | CA
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Zip | 95765-4386
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Country | US
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Telephone | 916-900-0246
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Fax | 916-970-0148
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Provider Business Mailing Address
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Address Line | 1426 CHEETAH ST
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City | ROCKLIN
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State | CA
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Zip | 95765-5737
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Country | US
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Telephone | 801-361-3480
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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 | 10812349-9922
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 104820
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License Number State | CA
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