Provider Demographics
NPI:1639585557
Name:JACOBS, DION (DDS)
Entity Type:Individual
Prefix:
First Name:DION
Middle Name:
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 1:9864 LUCKEY DR
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:NY
Mailing Address - Zip Code:14744-8706
Mailing Address - Country:US
Mailing Address - Phone:617-256-5737
Mailing Address - Fax:
Practice Address - Street 1:9864 LUCKEY DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:NY
Practice Address - Zip Code:14744-8706
Practice Address - Country:US
Practice Address - Phone:617-256-5737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058236-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist