Provider Demographics
NPI:1700039518
Name:DR. JACOB ATKINSON DMD PC
Entity Type:Organization
Organization Name:DR. JACOB ATKINSON DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-473-9166
Mailing Address - Street 1:130 COURT ST S
Mailing Address - Street 2:
Mailing Address - City:VALE
Mailing Address - State:OR
Mailing Address - Zip Code:97918-1326
Mailing Address - Country:US
Mailing Address - Phone:541-473-9166
Mailing Address - Fax:
Practice Address - Street 1:130 COURT ST S
Practice Address - Street 2:
Practice Address - City:VALE
Practice Address - State:OR
Practice Address - Zip Code:97918-1326
Practice Address - Country:US
Practice Address - Phone:541-473-9166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9126261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental