Provider Demographics
NPI:1386924785
Name:JACOBSON, DAVID SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:JACOBSON
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 1:276 E IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-5036
Mailing Address - Country:US
Mailing Address - Phone:702-290-2054
Mailing Address - Fax:
Practice Address - Street 1:62 E THRIVE DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-5558
Practice Address - Country:US
Practice Address - Phone:385-200-0613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10687964-99231223P0221X, 1223P0221X
MO20210288441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry