Provider Demographics
NPI:1770610891
Name:JACOB, SEEMA Z (DDS)
Entity type:Individual
Prefix:DR
First Name:SEEMA
Middle Name:Z
Last Name:JACOB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 BLUE HILL AVE STE B
Mailing Address - Street 2:SUITE B
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-3258
Mailing Address - Country:US
Mailing Address - Phone:617-287-0007
Mailing Address - Fax:617-287-0009
Practice Address - Street 1:614 B, BLUE HILL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121
Practice Address - Country:US
Practice Address - Phone:617-287-0007
Practice Address - Fax:617-287-0009
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21754122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0206393Medicaid