Active NPI
John Nathan Jacobsen, D.D.S.
- Dentist
- Oklahoma City, OK
National Provider Identifier
1225559404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6926
- Practice address
- 235 SW 25TH St.
Oklahoma City, OK 73109 - Phone
- (405) 295-4967
- Fax
- (405) 295-4969
- NPI assigned
- Jun 28, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6926 | OK | Primary |
Addresses
Primary practice location
235 SW 25TH St.
Oklahoma City, OK 73109
Mailing address
235 SW 25TH St
Oklahoma City, OK 73109
Phone (405) 295-4967
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6926 | OK | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498608000000",
"number": "1225559404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "235 SW 25TH ST",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "73109",
"telephone_number": "405-295-4967",
"fax_number": "405-295-4969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "235 SW 25TH ST.",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "73109",
"telephone_number": "405-295-4967",
"fax_number": "405-295-4969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSEN",
"first_name": "JOHN",
"middle_name": "NATHAN",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-28",
"last_updated": "2017-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OK",
"license": "6926",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.