Provider Demographics
NPI:1295931871
Name:JAMES A. JACOBSON DDS, INC.
Entity type:Organization
Organization Name:JAMES A. JACOBSON DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-722-5022
Mailing Address - Street 1:56 PENNY LN STE B
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-6018
Mailing Address - Country:US
Mailing Address - Phone:831-722-5022
Mailing Address - Fax:831-722-5912
Practice Address - Street 1:56 PENNY LN STE B
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-6018
Practice Address - Country:US
Practice Address - Phone:831-722-5022
Practice Address - Fax:831-722-5912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA196341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty