Provider Demographics
NPI:1508969890
Name:JACOBS, DALE TRAVERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:TRAVERS
Last Name:JACOBS
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 1:12225 GREENVILLE AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2081
Mailing Address - Country:US
Mailing Address - Phone:972-235-7060
Mailing Address - Fax:972-235-1588
Practice Address - Street 1:12225 GREENVILLE AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2081
Practice Address - Country:US
Practice Address - Phone:972-235-7060
Practice Address - Fax:972-235-1588
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice