Sam F. Jacoby, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

4650 Issued in NE

Practice address

1006 Main Street
Bridgeport, NE 69336-0864

Phone

(308) 262-1434

Fax

(308) 262-1436

NPI assigned

May 24, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mpda Bridgeport LLC

  dba Bridgeport Family Dental

  • General Practice Dentistry
  • Bridgeport, NE
  • NPI 1336966795
  NPD (past)

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184835183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 MAIN STREET",
            "address_2": "P.O. BOX 864",
            "city": "BRIDGEPORT",
            "state": "NE",
            "postal_code": "693360864",
            "telephone_number": "308-262-1434",
            "fax_number": "308-262-1436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 MAIN STREET",
            "city": "BRIDGEPORT",
            "state": "NE",
            "postal_code": "693360864",
            "telephone_number": "308-262-1434",
            "fax_number": "308-262-1436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBY",
        "first_name": "SAM",
        "middle_name": "F.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NE",
            "license": "4650",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "105307",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47-071304413",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Faye Ilene Hart-Maddux
• Heritage of Bridgeport, Inc (Heritage of Bridgeport)
• Benjamin Robert Iske
• J & J Nein LLC (Nein Pharmacy LTC)
• J & J Nein LLC (Nein Pharmacy)
• Chelsey Marie Kraupie, PT, DPT
• Stacy Kraupie
• Joleen Lapierre
• Cheryl A. Laux, APRN
• Melody J Leisy, APRN

• Dentist in Bridgeport, NE
• Providers in Bridgeport, NE by specialty
• Dentist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.