Provider Demographics
NPI:1790802676
Name:JACOBSON, PATRECIA TAPLIN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:PATRECIA
Middle Name:TAPLIN
Last Name:JACOBSON
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 1:704 E HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-1744
Mailing Address - Country:US
Mailing Address - Phone:218-262-3730
Mailing Address - Fax:218-262-5546
Practice Address - Street 1:704 E HOWARD ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-1744
Practice Address - Country:US
Practice Address - Phone:218-262-3730
Practice Address - Fax:218-262-5546
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND108971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice