Individual
DR. STACEY LYNN JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
19 BROADWAY, NEWPORT, RI 02840-2937
(401) 845-0564
(401) 847-4245
Mailing address
42 FAREWELL ST, APT 2, NEWPORT, RI 02840-2564
(401) 845-0564
(401) 847-4245
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEN02937
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1223G0001X
TAXONOMY NUMBER
RI
01
—
1881611390
NPI NUMBER
RI
05
—
JS61781
—
RI
Enumeration date
07/17/2006
Last updated
09/26/2011
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