# DR. JACOB DEAN ANDERSEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1174109789
- **Gender:** Man
- **Credential:** DMD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 38676 | TX | Yes |
| 122300000X | Dentist | 5971582 | ID | — |
| 1223G0001X | General Practice Dentistry | 00000 | NV | — |

## Other

- **Enumeration date:** 03/23/2021
- **Last updated:** 01/06/2026