Provider Demographics
NPI:1831261817
Name:JACOBS, NAOMI B (DDS)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:B
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 WILMINGTON DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-6299
Mailing Address - Country:US
Mailing Address - Phone:970-484-4850
Mailing Address - Fax:970-484-2757
Practice Address - Street 1:1927 WILMINGTON DR
Practice Address - Street 2:SUITE 202
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-6299
Practice Address - Country:US
Practice Address - Phone:970-484-4850
Practice Address - Fax:970-484-2757
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO82481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice