Provider Demographics
NPI:1578716015
Name:JACOBSEN, ELIZABETH HEADLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HEADLEY
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 8TH ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4556
Mailing Address - Country:US
Mailing Address - Phone:253-939-6900
Mailing Address - Fax:253-939-3667
Practice Address - Street 1:1348 8TH ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4556
Practice Address - Country:US
Practice Address - Phone:253-939-6900
Practice Address - Fax:253-939-3667
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60041232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist