MEDICARE: THOMAS M JACOBY DMD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11120	MA

General Provider Information

NPI Number	:	1104975556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS M JACOBY DMD PC

Provider Business Mailing Address
First Line	:	411 MASSACHUSETTS AVE
Second Line	:
City	:	ACTON
State	:	MA
Zip	:	01720-3739
Country	:	US
Telephone Number	:	978-263-9377
Fax Number	:	978-264-0759

Provider Business Practice Location Address
First Line	:	411 MASSACHUSETTS AVE
Second Line	:
City	:	ACTON
State	:	MA
Zip	:	01720-3739
Country	:	US
Telephone Number	:	978-263-9377
Fax Number	:	978-264-0759

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS M JACOBY
Credential	:	DMD
Telephone Number	:	978-263-9377

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	12/26/2012

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