Individual
DR. SAM F. JACOBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1006 MAIN STREET, BRIDGEPORT, NE 69336-0864
(308) 262-1434
(308) 262-1436
Mailing address
1006 MAIN STREET, P.O. BOX 864, BRIDGEPORT, NE 69336-0864
(308) 262-1434
(308) 262-1436
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
105307
CO
122300000X
Dentist
Primary
4650
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47-071304413
—
NE
Enumeration date
05/24/2007
Last updated
07/08/2007
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