Provider Demographics
NPI:1336683770
Name:JACOBS, ALLISON E (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:E
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 LOCKWOOD PL
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2267
Mailing Address - Country:US
Mailing Address - Phone:859-250-8438
Mailing Address - Fax:
Practice Address - Street 1:4845 RIALTO RD STE A
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2910
Practice Address - Country:US
Practice Address - Phone:513-772-6500
Practice Address - Fax:513-772-2002
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9759122300000X
OH30.0259431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist