MEDICARE: DR. NANCY JACOBSON D.M.D.

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	122300000X	Dentist	DN 12471	FL
2	1223G0001X	General Practice Dentistry	0112	NC

General Provider Information

NPI Number	:	1679530521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY JACOBSON D.M.D.

Provider Business Mailing Address
First Line	:	EAST CAROLINA UNIVERSITY
Second Line	:	1851 MACGREGOR DOWNS ROAD
City	:	GREENVILLE
State	:	NC
Zip	:	27834
Country	:	US
Telephone Number	:	252-737-7053
Fax Number	:	252-737-7049

Provider Business Practice Location Address
First Line	:	EAST CAROLINA UNIVERSITY
Second Line	:	1851 MACGREGOR DOWNS ROAD
City	:	GREENVILLE
State	:	NC
Zip	:	27834
Country	:	US
Telephone Number	:	252-737-7053
Fax Number	:	252-737-7049

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	03/07/2023

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