Provider Demographics
NPI:1316252208
Name:JACOBSON, SHARON S (DMD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:S
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WESTMINSTER PL
Mailing Address - Street 2:#4
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3351
Mailing Address - Country:US
Mailing Address - Phone:718-490-8939
Mailing Address - Fax:
Practice Address - Street 1:25 WESTMINSTER PL
Practice Address - Street 2:#4
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3351
Practice Address - Country:US
Practice Address - Phone:718-490-8939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024494001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice