Provider Demographics
NPI:1265760698
Name:JACOBSON, STEVEN EUGENE (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EUGENE
Last Name:JACOBSON
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 1:44550 VILLAGE CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3817
Mailing Address - Country:US
Mailing Address - Phone:760-674-4410
Mailing Address - Fax:760-674-4414
Practice Address - Street 1:44550 VILLAGE CT
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3817
Practice Address - Country:US
Practice Address - Phone:760-674-4410
Practice Address - Fax:760-674-4414
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA525211223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics