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NPI Code Detail

MEDICARE: JACOBSON DENTAL CORP

MEDICARE: JACOBSON DENTAL CORP
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
1261QD0000XDental Clinic/Center
21223X0400XOrthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number : 1962169433
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACOBSON DENTAL CORP
Provider Business Mailing Address
First Line : 3655 TORRANCE BLVD STE 425
Second Line :
City : TORRANCE
State : CA
Zip : 90503-4844
Country : US
Telephone Number : 916-877-7450
Fax Number : 844-534-8464
Provider Business Practice Location Address
First Line : 1535 SPRINGFIELD DR STE 110
Second Line :
City : CHICO
State : CA
Zip : 95928-6398
Country : US
Telephone Number : 530-694-4440
Fax Number : 844-534-8464
Authorized Official
Title or Position : OWNER
Name : DR. JEFFREY JACOBSON
Credential : DMD
Telephone Number : 916-877-7450
Provider Enumeration Date : 11/19/2021
Last Update Date : 03/06/2024

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Directions to “JACOBSON DENTAL CORP ” Practice Location

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