Provider Demographics
NPI:1083904734
Name:JACOBSON, LISA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:230 W JERSEY ST
Mailing Address - Street 2:MEDICAL ARTS BUILDING, SUITE 209, C/O DR. W. SILVERMAN
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1364
Mailing Address - Country:US
Mailing Address - Phone:908-229-1345
Mailing Address - Fax:908-353-1888
Practice Address - Street 1:230 W JERSEY ST
Practice Address - Street 2:MEDICAL ARTS BUILDING, SUITE 209, C/O DR. W. SILVERMAN
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1364
Practice Address - Country:US
Practice Address - Phone:908-229-1345
Practice Address - Fax:908-353-1888
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJDI019830071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice