Provider Demographics
NPI:1669521977
Name:JACOBSON, RALPH W (DDS)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:W
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 1:9145 SW 40TH ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5371
Mailing Address - Country:US
Mailing Address - Phone:305-221-1902
Mailing Address - Fax:305-223-1021
Practice Address - Street 1:9145 SW 40TH ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5371
Practice Address - Country:US
Practice Address - Phone:305-221-1902
Practice Address - Fax:305-223-1021
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN35671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice