NPIMap

Organization Active NPI

Jacobson Dental Corp

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Lodi, CA
National Provider Identifier
1962034991
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
JACOBSON DENTAL CORP
Practice address
1139 E. Kettleman Lane
Suite 101
Lodi, CA 95240
Phone
(209) 642-8990
Fax
(844) 534-8464
NPI assigned
Feb 7, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

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

Authorized official

Name
Dr. Jeffrey Jacobson, DMD
Title
Owner
Phone
(916) 877-7450

Specialties & licenses 1

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

Addresses

Primary practice location

1139 E. Kettleman Lane
Suite 101
Lodi, CA 95240

Mailing address

3655 Torrance Blvd Ste 425
Torrance, CA 90503-4844
Phone (916) 877-7450

Other names 2

  • Children's Choice Dental Care Doing business as
  • Jacobson Dental Corp Other name

National Provider Directory

National Provider Directory
Tax ID family
Children'S Choice Dental Care15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

1139 E Kettleman Ln
Lodi, CA 95240
Phone (209) 642-8990

1139 E Kettleman Ln
Ste 101
Lodi, CA 95240
Phone (209) 642-8990

Practitioners & affiliated clinicians

Practitioners 1

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": "1581033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1962034991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3655 TORRANCE BLVD STE 425",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905034844",
            "telephone_number": "916-877-7450",
            "fax_number": "844-534-8464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1139 E. KETTLEMAN LANE",
            "address_2": "SUITE 101",
            "city": "LODI",
            "state": "CA",
            "postal_code": "95240",
            "telephone_number": "209-642-8990",
            "fax_number": "844-534-8464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOBSON DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-07",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-877-7450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Choice Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Children's Choice Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jacobson Dental Corp",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lodi, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; 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.