Provider Demographics
NPI:1427286855
Name:JACOBS, SARAH ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ANN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5316 BUNTING RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-6293
Mailing Address - Country:US
Mailing Address - Phone:217-299-0249
Mailing Address - Fax:
Practice Address - Street 1:2525 W ILES AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4283
Practice Address - Country:US
Practice Address - Phone:217-299-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6406-015122300000X
IL019.027986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist