Timothy Dale Jacobson, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

11661 Issued in MN

Practice address

1411 W Saint Germain St
Suite #103
Saint Cloud, MN 56301-4121

Phone

(320) 253-2121

NPI assigned

Nov 21, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Dr's Colt and Jacobsons, LTD

  • General Practice Dentistry
  • Saint Cloud, MN
  • NPI 1396810008
  NPD (past)

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1326113127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 W SAINT GERMAIN ST",
            "address_2": "SUITE #103",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014121",
            "telephone_number": "320-253-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 W SAINT GERMAIN ST",
            "address_2": "SUITE #103",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014121",
            "telephone_number": "320-253-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "TIMOTHY",
        "middle_name": "DALE",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "11661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dale Everett Jacobson, D.D.S.
• Geri Newman Jacobson, MD
• Julia Jacobson, M.D.
• Rolf L Jacobson, DDS
• Stacey Ann Jacobson, RN
• Jacy 1 (Anchorage)
• Brett Anthony Jahnke
• Hassan Jailani
• Sandeep S Jain, MBBS
• Dani U Jakubowski, PHD LP

• Dentist in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Dentist in Minnesota

• 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.

Verify at the official NPI Registry.