Provider Demographics
NPI:1881812550
Name:JACOBSON, BAILEY NORMAN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BAILEY
Middle Name:NORMAN
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:4200 W PETERSON AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6074
Mailing Address - Country:US
Mailing Address - Phone:773-545-5333
Mailing Address - Fax:773-545-3636
Practice Address - Street 1:4200 W PETERSON AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6074
Practice Address - Country:US
Practice Address - Phone:773-545-5333
Practice Address - Fax:773-545-3636
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics