Provider Demographics
NPI:1093887341
Name:JACOBI, ERIC P (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:P
Last Name:JACOBI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W PENN AVE
Mailing Address - Street 2:
Mailing Address - City:ROBESONIA
Mailing Address - State:PA
Mailing Address - Zip Code:19551
Mailing Address - Country:US
Mailing Address - Phone:610-693-6508
Mailing Address - Fax:
Practice Address - Street 1:105 W PENN AVE
Practice Address - Street 2:
Practice Address - City:ROBESONIA
Practice Address - State:PA
Practice Address - Zip Code:19551
Practice Address - Country:US
Practice Address - Phone:610-693-6508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020392L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS020392LOtherDENTAL LICENSE COMMONWEAL