Provider Demographics
NPI:1184644684
Name:JACOBS, AMELIA C (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:C
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:15213 CRYSTAL SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5285
Mailing Address - Country:US
Mailing Address - Phone:502-245-0189
Mailing Address - Fax:502-937-8447
Practice Address - Street 1:4816 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3634
Practice Address - Country:US
Practice Address - Phone:502-935-7212
Practice Address - Fax:502-937-8447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY51791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics