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General NPI Number Information
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NPI Number | 1750741716
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Entity Type | Individual
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Provider Name | CASEY JACOBSEN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 6360 US HIGHWAY 93 S
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City | WHITEFISH
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State | MT
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Zip | 59937-8235
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Country | US
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Telephone | 406-862-7895
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Fax |
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Provider Business Mailing Address
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Address Line | 400 12TH AVE WEST
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City | COLUMBIA FALLS
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State | MT
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Zip | 59912
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Country | US
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Telephone | 406-892-2104
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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 | DR60651464
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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 | DE60732567
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 16442
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License Number State | MT
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