Provider Demographics
NPI:1568743755
Name:JACOBS, MICHAEL GRANT (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GRANT
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 1:129 W COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-1931
Mailing Address - Country:US
Mailing Address - Phone:303-738-9499
Mailing Address - Fax:303-738-9540
Practice Address - Street 1:129 W COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-1931
Practice Address - Country:US
Practice Address - Phone:303-738-9499
Practice Address - Fax:303-738-9540
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice