Provider Demographics
NPI:1952521478
Name:JACOBS, LAMONT BREGG (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LAMONT
Middle Name:BREGG
Last Name:JACOBS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 NILLES RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2912
Mailing Address - Country:US
Mailing Address - Phone:513-829-7045
Mailing Address - Fax:513-829-7371
Practice Address - Street 1:1242 NILLES RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2912
Practice Address - Country:US
Practice Address - Phone:513-829-7045
Practice Address - Fax:513-829-7371
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300183621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics