Provider Demographics
NPI:1407609126
Name:JACOBSON DENTAL CORP
Entity Type:Organization
Organization Name:JACOBSON DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AM
Authorized Official - Prefix:
Authorized Official - First Name:KUSHBOO
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-877-7450
Mailing Address - Street 1:325 S HIGLEY RD STE 130
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4703
Mailing Address - Country:US
Mailing Address - Phone:916-877-7450
Mailing Address - Fax:
Practice Address - Street 1:1230 CHURN CREEK RD STE 100
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4033
Practice Address - Country:US
Practice Address - Phone:530-738-2090
Practice Address - Fax:844-534-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty