Provider Demographics
NPI:1881012169
Name:PARSONS, JACOB DUANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:DUANE
Last Name:PARSONS
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 1:1200 UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-2355
Mailing Address - Country:US
Mailing Address - Phone:515-248-1447
Mailing Address - Fax:515-248-1440
Practice Address - Street 1:101 IOWA AVENUE W
Practice Address - Street 2:STE 102
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4768
Practice Address - Country:US
Practice Address - Phone:641-753-4021
Practice Address - Fax:515-644-6792
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMD4116122300000X
IADDS-093651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM17158052Medicaid