Brett Dean Jacobson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-3203 Issued in ID

Practice address

1088 N Skyline Dr
Idaho Falls, ID 83402-1726

Phone

(208) 524-0870

Fax

(208) 524-0873

NPI assigned

Dec 11, 2006

Last updated

Aug 7, 2020By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

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

Practice roles

Locations

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.

• Parkwest Dental Care

  • Dental Clinic/Center
  • Idaho Falls, ID
  • NPI 1861666745
  NPD Authorized official
• Grin PLLC

  • General Practice Dentistry
  • Idaho Falls, ID
  • NPI 1144720103
  NPD (past)

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596758400000",
    "number": "1811057623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 PANCHERI DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023344",
            "telephone_number": "208-524-0870",
            "fax_number": "208-524-0873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1088 N SKYLINE DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834021726",
            "telephone_number": "208-524-0870",
            "fax_number": "208-524-0873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "BRETT",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2020-08-07",
        "certification_date": "2020-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3203",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003552200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dallin Jackman
• Beverly Joanne Jackson
• Kenneth William Jackson, PA
• Lyle Jeremy Jackson, CRNA
• Brandon Thomas Jacobson, DMD
• Lance Glen Jacobson, MD
• Jennifer Jahn
• Bradley James
• Daisy Kay James, LMSW
• Michael K. James, DPM

• General Practice Dentistry in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2020; 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.