Provider Demographics
NPI:1679530521
Name:JACOBSON, NANCY (DMD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:JACOBSON
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:EAST CAROLINA UNIVERSITY
Mailing Address - Street 2:1851 MACGREGOR DOWNS ROAD
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-737-7053
Mailing Address - Fax:252-737-7049
Practice Address - Street 1:EAST CAROLINA UNIVERSITY
Practice Address - Street 2:1851 MACGREGOR DOWNS ROAD
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-737-7053
Practice Address - Fax:252-737-7049
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 12471122300000X
NC01121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBJ 2643749OtherDEA