MEDICARE: DOUGLAS JACOBUS DDS, MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	22DI02641300	NJ

General Provider Information

NPI Number	:	1427443282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS JACOBUS DDS, MD

Provider Business Mailing Address
First Line	:	50 DIVISION ST STE 301
Second Line	:
City	:	SOMERVILLE
State	:	NJ
Zip	:	08876-2943
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 DIVISION ST STE 301
Second Line	:
City	:	SOMERVILLE
State	:	NJ
Zip	:	08876-2943
Country	:	US
Telephone Number	:	908-725-5585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	05/04/2021

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