Provider Demographics
NPI:1720237902
Name:JACOBS, ALVIN CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:CHARLES
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 1:1625 ANDERSON AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2748
Mailing Address - Country:US
Mailing Address - Phone:201-944-1331
Mailing Address - Fax:201-585-2041
Practice Address - Street 1:1625 ANDERSON AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2748
Practice Address - Country:US
Practice Address - Phone:201-944-1331
Practice Address - Fax:201-585-2041
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD092431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice