Provider Demographics
NPI:1023272358
Name:JACOBS, DUSTIN CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:CHRISTOPHER
Last Name:JACOBS
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 1:1930 BUFORD MILL DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-8602
Mailing Address - Country:US
Mailing Address - Phone:770-882-2539
Mailing Address - Fax:
Practice Address - Street 1:1930 BUFORD MILL DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-8602
Practice Address - Country:US
Practice Address - Phone:770-882-2539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0137821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice