# JACOBS DENTAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871293688
- **Authorized official:** DR. TIMOTHY L JACOBS D.D.S. (OWNER)
- **Authorized official phone:** (308) 382-6660

## Contact information

- **Practice address:** 2916 W STOLLEY PARK ROAD, SUITE B, GRAND ISLAND, NE 68801-6807
- **Practice address phone:** (308) 382-6660
- **Practice address fax:** (308) 381-9809
- **Mailing address:** 2916 W STOLLEY PARK ROAD, SUITE B, GRAND ISLAND, NE 68801-6807
- **Mailing address phone:** (308) 382-6660
- **Mailing address fax:** (308) 381-9809

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 03/09/2023
- **Last updated:** 03/09/2023