Ellen Denise Jacobson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D13690 Issued in MN

Practice address

14682 Pennock Avenue South
Apple Valley, MN 55124

Phone

(952) 431-5774

Fax

(952) 431-0862

NPI assigned

Jun 3, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dakota Dental Clinic PA

  • General Practice Dentistry
  • Apple Valley, MN
  • NPI 1063559540
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464912000000",
    "number": "1134578826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14682 PENNOCK AVENUE SOUTH",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "55124",
            "telephone_number": "952-431-5774",
            "fax_number": "952-431-0862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14682 PENNOCK AVENUE SOUTH",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "55124",
            "telephone_number": "952-431-5774",
            "fax_number": "952-431-0862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "ELLEN",
        "middle_name": "DENISE",
        "name_prefix": "Miss",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-03",
        "last_updated": "2016-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ind School Dist 196
• Iris Mental Health, LLC (Iris Mental Health & Wellness)
• Tracy Jo Irons-Dieterle, NP-C
• Bennett Edward Isabella, D.D.S.
• Rahima Abdullahi Ismail
• Jbouti Jama
• Rana Kraftson Jaszczak, DPT
• Joelle Jefferson, LGSW
• Casey Jenness, PHARMD
• Anna Marie Jennison, P.T.

• Dentist in Apple Valley, MN
• Providers in Apple Valley, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.