# BRIAN J JACOBSEN DMD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jacobsen Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942758180
- **Authorized official:** DR. BRIAN JAMES JACOBSEN D.M.D. (OWNER)
- **Authorized official phone:** (509) 754-3262

## Contact information

- **Practice address:** 103 1ST AVE SW, EPHRATA, WA 98823-1842
- **Practice address phone:** (509) 754-3262
- **Practice address fax:** (509) 754-4975
- **Mailing address:** 103 1ST AVE SW, EPHRATA, WA 98823-1842
- **Mailing address phone:** (509) 754-3262
- **Mailing address fax:** (509) 754-4975

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 60128176 | WA | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 09/16/2016
- **Last updated:** 09/16/2016