Provider Demographics
NPI:1407002496
Name:HAMBLIN, JACOB SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:SCOTT
Last Name:HAMBLIN
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 1:10011 CENTENNIAL PKWY
Mailing Address - Street 2:SUITE 540
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4156
Mailing Address - Country:US
Mailing Address - Phone:801-255-7645
Mailing Address - Fax:801-255-9667
Practice Address - Street 1:10011 CENTENNIAL PKWY
Practice Address - Street 2:SUITE 540
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4156
Practice Address - Country:US
Practice Address - Phone:801-255-7645
Practice Address - Fax:801-255-9667
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV47581223G0001X
UT377590-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice