Organization
KENTUCKY DENTAL ANESTHESIA SERVICES
Active
Other names
Kentucky Dental Anesthesia Services
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC JACOBSON DMD (MEMBER)
(859) 420-9187
Entity
Organization
Contact information
Practice address
1006 ACE DR, BEREA, KY 40403-1327
(859) 420-9187
Mailing address
1006 ACE DR, BEREA, KY 40403-1327
(859) 420-9187
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP3000X
Pediatric Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
07/12/2023
Last updated
10/30/2024
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