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NPI Code Detail

MEDICARE: DR. MILES J JACOBSEN DDS

MEDICARE: DR. MILES J JACOBSEN DDS
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
1122300000XDentist61458KS

General Provider Information

NPI Number : 1457877011
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MILES J JACOBSEN DDS
Provider Business Mailing Address
First Line : 10437 E FAWN GROVE CT
Second Line :
City : WICHITA
State : KS
Zip : 67207-4364
Country : US
Telephone Number : 316-644-3298
Fax Number :
Provider Business Practice Location Address
First Line : 2838 N OLIVER ST
Second Line :
City : WICHITA
State : KS
Zip : 67220-2983
Country : US
Telephone Number : 316-978-8350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2017
Last Update Date : 08/16/2017

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Directions to “ DR. MILES J JACOBSEN DDS” Practice Location

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