Provider Demographics
NPI:1114931474
Name:YOSAFAT, JACOB (DDS)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:YOSAFAT
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 1:3540 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1331
Mailing Address - Country:US
Mailing Address - Phone:513-385-8482
Mailing Address - Fax:513-385-5705
Practice Address - Street 1:3540 SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1331
Practice Address - Country:US
Practice Address - Phone:513-385-8482
Practice Address - Fax:513-385-5705
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist