Provider Demographics
NPI:1336367655
Name:JACOBS, RICHARD SAMUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SAMUEL
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 1:454 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1964
Mailing Address - Country:US
Mailing Address - Phone:302-892-9030
Mailing Address - Fax:302-792-2122
Practice Address - Street 1:3716 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-3412
Practice Address - Country:US
Practice Address - Phone:302-792-2648
Practice Address - Fax:302-792-2122
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10008501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice