Provider Demographics
NPI:1043432792
Name:JACOBS, GEORGE PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PAUL
Last Name:JACOBS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 REITZ BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9220
Mailing Address - Country:US
Mailing Address - Phone:570-523-3368
Mailing Address - Fax:
Practice Address - Street 1:260 REITZ BLVD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9220
Practice Address - Country:US
Practice Address - Phone:570-523-3368
Practice Address - Fax:570-523-9491
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-025048L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice