Active NPI
Charles Bryan Jakobsen, DDS
- General Practice Dentistry
- Phoenix, AZ
National Provider Identifier
1235292046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6266
- Practice address
- 4130 N 108TH Ave
Suite 103-104
Phoenix, AZ 85037-5774 - Phone
- (623) 772-9600
- Fax
- (623) 772-9601
- NPI assigned
- Dec 19, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6266 | AZ | Primary |
Addresses
Primary practice location
4130 N 108TH Ave
Suite 103-104
Phoenix, AZ 85037-5774
Mailing address
4044 W Alex Loop
Glendale, AZ 85310-2444
Phone (623) 209-4780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160408000785 | AZ | Order and Referring Only - Dentist | 8527366400 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Steven C. Chang DDS PC | General Practice | Past | Accepting new patients |
| Steven C. Chang DDS PC | General Practice | Past | Accepting new patients |
| Westview Family Dental Care, PLLC | General Practice | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- General Practice Dentistry
- Phoenix, AZ
- NPI 1932262607
-
- General Practice Dentistry
- Phoenix, AZ
- NPI 1255721148
-
dba A Beary Nice Smile
- Customized Equipment (DME)
- Glendale, AZ
- NPI 1487389573
General Practice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235292046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4044 W ALEX LOOP",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853102444",
"telephone_number": "623-209-4780",
"fax_number": "623-581-0793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4130 N 108TH AVE",
"address_2": "SUITE 103-104",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850375774",
"telephone_number": "623-772-9600",
"fax_number": "623-772-9601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAKOBSEN",
"first_name": "CHARLES",
"middle_name": "BRYAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "6266",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.