NPIMap

Organization Active NPI

Jacobson Orthodontic Associates, LTD

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Chicago, IL
National Provider Identifier
1508006313
Registry record updated Mar 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
060.004616 Issued in IL
Legal business name
JACOBSON ORTHODONTIC ASSOCIATES, LTD
Practice address
4200 W Peterson Ave
Suite 116
Chicago, IL 60646-6074
Phone
(773) 545-5333
Fax
(773) 545-3636
NPI assigned
Mar 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2009

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

Authorized official

Name
Dr. Ronald Scott Jacobson, D.D.S., M.S.NPI 1821120122
Title
President
Phone
(773) 545-5333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 060.004616 IL Primary

Addresses

Primary practice location

4200 W Peterson Ave
Suite 116
Chicago, IL 60646-6074

Mailing address

4200 W Peterson Ave
Suite 116
Chicago, IL 60646-6074
Phone (773) 545-5333

National Provider Directory

National Provider Directory

Locations

4200 W Peterson Ave
Ste 116
Chicago, IL 60646
Phone (773) 545-5333

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1236297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236297600000",
    "number": "1508006313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 W PETERSON AVE",
            "address_2": "SUITE 116",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606466074",
            "telephone_number": "773-545-5333",
            "fax_number": "773-545-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 W PETERSON AVE",
            "address_2": "SUITE 116",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606466074",
            "telephone_number": "773-545-5333",
            "fax_number": "773-545-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOBSON ORTHODONTIC ASSOCIATES, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-06",
        "last_updated": "2009-03-06",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-545-5333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "060.004616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2009; 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.