Active NPI
Blain Jacobson, DMD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Granite Bay, CA
National Provider Identifier
1700049749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 56390
- Practice address
- 6910 Douglas Blvd Ste a
Granite Bay, CA 95746-6276 - Phone
- (916) 813-5363
- NPI assigned
- Jul 9, 2008
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 56390 | CA | Primary |
Addresses
Primary practice location
6910 Douglas Blvd Ste a
Granite Bay, CA 95746-6276
Mailing address
6910 Douglas Blvd Ste a
#A
Granite Bay, CA 95746-6276
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 |
|---|---|---|---|
| 56390 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blain Jacobson, DMD, a Professional Dental Corporation | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Interoperability endpoints
- bjacobson@direct.westerndental.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Granite Bay, CA
- NPI 1487897831
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229558400000",
"number": "1700049749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6910 DOUGLAS BLVD STE A",
"address_2": "#A",
"city": "GRANITE BAY",
"state": "CA",
"postal_code": "957466276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6910 DOUGLAS BLVD STE A",
"city": "GRANITE BAY",
"state": "CA",
"postal_code": "957466276",
"telephone_number": "916-813-5363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "BLAIN",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-09",
"last_updated": "2008-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "56390",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granite Bay, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.