Provider Demographics
NPI:1760482004
Name:JACOBS, DONNA N (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:N
Last Name:JACOBS
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 1:8406 HILDA DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2282
Mailing Address - Country:US
Mailing Address - Phone:410-548-1566
Mailing Address - Fax:
Practice Address - Street 1:4 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:MD
Practice Address - Zip Code:21875-1610
Practice Address - Country:US
Practice Address - Phone:410-896-4200
Practice Address - Fax:410-543-2727
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD79351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice