Gary Lee Jacobsen, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

7648 Issued in IA

Practice address

200 N B St
Indianola, IA 50125-2429

Phone

(515) 961-8411

NPI assigned

Mar 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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 and National Provider Directory roles.

• Dental Professionals, PLC

  • General Practice Dentistry
  • Indianola, IA
  • NPI 1780851972
  NPD (past) Authorized official
• Iowa Dental Health Professionals, P.C.

  dba Dental Professionals

  • General Practice Dentistry
  • Indianola, IA
  • NPI 1508404245
  NPD (past)

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1205895166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N B ST",
            "city": "INDIANOLA",
            "state": "IA",
            "postal_code": "501252429",
            "telephone_number": "515-961-8411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N B ST",
            "city": "INDIANOLA",
            "state": "IA",
            "postal_code": "501252429",
            "telephone_number": "515-961-8411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "GARY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-20",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IA",
            "license": "7648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0422311",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Indianola Residential, LLC (Indianola Residential)
• Iowa Dental Health Professionals, P.C. (Dental Professionals)
• Iowa Hearing Instruments LLC (Miracle Ear)
• Iowa Physicians Clinic Medical Foundation (Indianola Family Medicine)
• Iowa Speech Therapy
• Gary Janssen, DO
• Alfreda Jarue
• Jaybird ABA LLC (Jaybird ABA)
• Jaybird Holdings Indianola LLC
• Chris Robert Jensen, M.D.

• Dentist in Indianola, IA
• Providers in Indianola, IA by specialty
• Dentist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.