NPIMap

Organization Active NPI

King of Prussia Dental Associates

  • General Practice Dentistry
  • King of Prussia, PA
National Provider Identifier
1619079704
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
06-0000001653 Issued in PA
Legal business name
KING OF PRUSSIA DENTAL ASSOCIATES
Practice address
491 Allendale Rd
Suite 306
King of Prussia, PA 19406-1432
Phone
(610) 265-4142
Fax
(610) 265-0926
NPI assigned
Sep 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Brad G Jacobson, DDSNPI 1427176288
Title
Owner
Phone
(610) 265-4142

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 06-0000001653 PA Primary

Addresses

Primary practice location

491 Allendale Rd
Suite 306
King of Prussia, PA 19406-1432

Mailing address

491 Allendale Rd
Suite 306
King of Prussia, PA 19406-1426
Phone (610) 265-4142

National Provider Directory

National Provider Directory

Locations

491 Allendale Rd
Ste 306
Kng of Prussa, PA 19406
Phone (610) 265-1202

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619079704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "491 ALLENDALE RD",
            "address_2": "SUITE 306",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194061426",
            "telephone_number": "610-265-4142",
            "fax_number": "610-265-0926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "491 ALLENDALE RD",
            "address_2": "SUITE 306",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194061432",
            "telephone_number": "610-265-4142",
            "fax_number": "610-265-0926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING OF PRUSSIA DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-265-4142",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "06-0000001653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in King of Prussia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.