Active NPI
Egill Lars Jacobsen, DDS
- Endodontics
- Addison, IL
National Provider Identifier
1841360195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- Practice address
- 33 S Addison Rd
Suite 103
Addison, IL 60101-3868 - Phone
- (630) 941-3316
- Fax
- (630) 941-7020
- NPI assigned
- Nov 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | IL | Primary |
Addresses
Primary practice location
33 S Addison Rd
Suite 103
Addison, IL 60101-3868
Mailing address
210 W Elm Park Ave
Elmhurst, IL 60126-3230
Phone (630) 834-7617
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 |
|---|---|---|---|
| 021.001281 | IL | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1841360195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 W ELM PARK AVE",
"city": "ELMHURST",
"state": "IL",
"postal_code": "601263230",
"telephone_number": "630-834-7617",
"fax_number": "630-941-7020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 S ADDISON RD",
"address_2": "SUITE 103",
"city": "ADDISON",
"state": "IL",
"postal_code": "601013868",
"telephone_number": "630-941-3316",
"fax_number": "630-941-7020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSEN",
"first_name": "EGILL",
"middle_name": "LARS",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Addison, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.