Dr. David Jacobs
Dentist, General Practice in Saint Clair Shores, MI. Individual provider (NPI-1).
NPI number1750763512
StatusActive
Last updated in NPPESJun 29, 2015
Details
- NPI
- 1750763512
- Entity type
- Individual (NPI-1)
- Name
- Dr. David Jacobs
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 29, 2015
- Last updated
- Jun 29, 2015
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · ORDER AND REFERRING ONLY - OTHER (PHYSICIAN)
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 2901021531 | MI | Yes |
Practice location
22811 Greater Mack AveSuite L-10
Saint Clair Shores, MI 48080-2021
Phone 586-774-2400
Mailing address
22811 Greater Mack AveSuite L-10
Saint Clair Shores, MI 48080-2021
Phone 586-774-2400
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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