Provider Demographics
NPI:1861840357
Name:JACOBSON, NATALIE NELSEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:NELSEN
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 1:502 MOUNT EDEN RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8871
Mailing Address - Country:US
Mailing Address - Phone:502-633-1538
Mailing Address - Fax:
Practice Address - Street 1:502 MOUNT EDEN RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8871
Practice Address - Country:US
Practice Address - Phone:502-633-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist