Provider Demographics
NPI:1275771222
Name:JACOBS ENTREPRENEURIAL GROUP
Entity Type:Organization
Organization Name:JACOBS ENTREPRENEURIAL GROUP
Other - Org Name:HIXSON DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-877-7886
Mailing Address - Street 1:1005 EXECUTIVE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-7903
Mailing Address - Country:US
Mailing Address - Phone:423-877-7886
Mailing Address - Fax:423-877-1290
Practice Address - Street 1:1005 EXECUTIVE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7903
Practice Address - Country:US
Practice Address - Phone:423-877-7886
Practice Address - Fax:423-877-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS8742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty