Provider Demographics
NPI:1194745844
Name:JACOBSON, THEODORE ERIC (DDS)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ERIC
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:THEODORE
Other - Middle Name:ERIC
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:450 SUTTER ST
Mailing Address - Street 2:2600
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:415-362-2167
Mailing Address - Fax:415-362-6402
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:2600
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-362-2167
Practice Address - Fax:415-362-6402
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA275291223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics