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General NPI Number Information
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NPI Number | 1669101317
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Entity Type | Individual
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Provider Name | JACOB TUFT DMD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 530 W 465 N STE 703
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City | PROVIDENCE
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State | UT
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Zip | 84332-8006
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Country | US
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Telephone | 435-999-0234
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Fax |
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Provider Business Mailing Address
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Address Line | 530 W 465 N STE 703
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City | PROVIDENCE
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State | UT
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Zip | 84332-8006
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Country | US
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Telephone | 801-615-1454
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 13673505
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 13673505
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2025044832
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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