Provider Demographics
NPI:1720746357
Name:COLUMBUS ENDODONTICS
Entity Type:Organization
Organization Name:COLUMBUS ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDON
Authorized Official - Middle Name:C
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:812-361-4051
Mailing Address - Street 1:5990 HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:BARGERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46106-8503
Mailing Address - Country:US
Mailing Address - Phone:812-361-4051
Mailing Address - Fax:
Practice Address - Street 1:3200 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-4426
Practice Address - Country:US
Practice Address - Phone:812-372-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12012180AOtherDENTAL LICENSE
INFJ6746638OtherDEA