Provider Demographics
NPI:1265886238
Name:JACOBS, KIMBERLY (DMD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:JACOBS
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 1:1590 MEDICAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3247
Mailing Address - Country:US
Mailing Address - Phone:610-323-1004
Mailing Address - Fax:
Practice Address - Street 1:1590 MEDICAL DR STE C
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3247
Practice Address - Country:US
Practice Address - Phone:610-323-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0416331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry