Active NPI
Theodore Edward Jacobson, DMD
- Oral and Maxillofacial Surgery (Dentist)
- Fresno, CA
National Provider Identifier
1417649088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- DDS112415
- Practice address
- 215 N Fresno St Ste 490
Fresno, CA 93701-2363 - Phone
- (559) 459-4191
- NPI assigned
- May 23, 2023
- 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 |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | DDS112415 | CA | Primary |
Addresses
Primary practice location
215 N Fresno St Ste 490
Fresno, CA 93701-2363
Mailing address
215 N Fresno St Ste 490
Fresno, CA 93701-2363
Phone (559) 459-4191
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 |
|---|---|---|---|
| DDS112415 | CA | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769990400000",
"number": "1417649088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 N FRESNO ST STE 490",
"city": "FRESNO",
"state": "CA",
"postal_code": "937012363",
"telephone_number": "559-459-4191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 N FRESNO ST STE 490",
"city": "FRESNO",
"state": "CA",
"postal_code": "937012363",
"telephone_number": "559-459-4191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "THEODORE",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-23",
"last_updated": "2026-02-02",
"certification_date": "2026-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "CA",
"license": "DDS112415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 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.