Jacobs, Stacey Lynn

Jacobs, Stacey Lynn is an individual health care provider with primary practice located at 19 Broadway , Newport RI 02840-2937. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Jacobs, Stacey Lynn can be contacted via phone (401) 845-0564.

Contact Information

Primary practice address
19 Broadway Newport RI 02840-2937
Phone: (401) 845-0564
Fax: (401) 847-4245
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X DEN02937 Rhode Island

Profile Details

NPI number 1881611390
LBN Legal business name Jacobs, Stacey Lynn
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 17th, 2006
Last updated Sep 26th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881611390 NPPES
Rhode Island Other 1223G0001X TAXONOMY NUMBER
Rhode Island Other 1881611390 TAXONOMY NUMBER
Rhode Island MEDICAID JS61781 TAXONOMY NUMBER

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