MEDICARE: M.C. JACOBSON PA

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	4113	FL

General Provider Information

NPI Number	:	1609985662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M.C. JACOBSON PA

Provider Business Mailing Address
First Line	:	38 NE 20TH AVE
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6548
Country	:	US
Telephone Number	:	954-942-2550
Fax Number	:	954-942-2551

Provider Business Practice Location Address
First Line	:	38 NE 20TH AVE
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6548
Country	:	US
Telephone Number	:	954-942-2550
Fax Number	:	954-942-2551

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MILTON CHARLES JACOBSON
Credential	:	DDS
Telephone Number	:	954-942-2550

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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