Kathy Jacobsen, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D4743 Issued in AZ

Practice address

1170 N Gilbert Rd
Suite 125
Gilbert, AZ 85234-2340

Phone

(480) 507-1807

Fax

(480) 813-5833

NPI assigned

Apr 17, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Kathy Ann Wilson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275759722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1170 N GILBERT RD",
            "address_2": "SUITE 125",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342340",
            "telephone_number": "480-507-1807",
            "fax_number": "480-813-5833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1170 N GILBERT RD",
            "address_2": "SUITE 125",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342340",
            "telephone_number": "480-507-1807",
            "fax_number": "480-813-5833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "KATHY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D4743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHY",
            "last_name": "WILSON",
            "middle_name": "ANN",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jacob Zuniga,DDS,LLC
• Allison Jacobs
• Julie Lynne Jacobs, MA LPC
• Katie Mae Jacobs, PA
• Martha Walton Jacobs, M.A.
• Aaron J Jacobson
• Brandon Max Jacobson
• Valerie Jacovides, RN,MSN,FNP-C
• Christie Jacques, DDS
• Brooke Jacquez, BCBA

• Dentist in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Dentist in Arizona

• 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.