Provider Demographics
NPI:1477124576
Name:JACOBI, JULIA LANE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:LANE
Last Name:JACOBI
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 1:2121 MILLERVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-1896
Mailing Address - Country:US
Mailing Address - Phone:225-960-4407
Mailing Address - Fax:
Practice Address - Street 1:2121 MILLERVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1896
Practice Address - Country:US
Practice Address - Phone:225-960-4407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7481122300000X
AZ011099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist