Organization
GARY B JACOBSEN DDS, A PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY BRUCE JACOBSEN (DDS/PRESIDENT)
(626) 445-8048
Entity
Organization
Contact information
Practice address
301 W HUNTINGTON DR, SUITE 204, ARCADIA, CA 91007-3462
(626) 445-8048
(626) 445-8128
Mailing address
301 W HUNTINGTON DR, SUITE 204, ARCADIA, CA 91007-3462
(626) 445-8048
(626) 445-8128
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
26077
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295885382
INDIVIDUAL NPI NUMBER
CA
Enumeration date
08/12/2014
Last updated
08/12/2014
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