Provider Demographics
NPI:1962034991
Name:JACOBSON DENTAL CORP
Entity Type:Organization
Organization Name:JACOBSON DENTAL CORP
Other - Org Name:CHILDREN'S CHOICE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-877-7450
Mailing Address - Street 1:3655 TORRANCE BLVD STE 425
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4844
Mailing Address - Country:US
Mailing Address - Phone:916-877-7450
Mailing Address - Fax:844-534-8464
Practice Address - Street 1:1139 E. KETTLEMAN LANE
Practice Address - Street 2:SUITE 101
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240
Practice Address - Country:US
Practice Address - Phone:209-642-8990
Practice Address - Fax:844-534-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty