Provider Demographics
NPI:1679896187
Name:JACOBS, BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
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 1:1708 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4611
Mailing Address - Country:US
Mailing Address - Phone:954-456-3366
Mailing Address - Fax:954-456-3176
Practice Address - Street 1:1708 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4611
Practice Address - Country:US
Practice Address - Phone:954-456-3366
Practice Address - Fax:954-456-3176
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN54141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice