Provider Demographics
NPI:1215946397
Name:JACOBI, JOSEPH W (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:W
Last Name:JACOBI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-8013
Mailing Address - Country:US
Mailing Address - Phone:812-283-5550
Mailing Address - Fax:812-280-0332
Practice Address - Street 1:1706 WILLIAMSBURG DR
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-8013
Practice Address - Country:US
Practice Address - Phone:812-283-5550
Practice Address - Fax:812-280-0332
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1200A72471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8314OtherDENTAL LICENSE
IN1200A7247OtherDENTAL LICENSE