Provider Demographics
NPI:1982157681
Name:JACOBS, SCOTT (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2269 MARKET GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8525
Mailing Address - Country:US
Mailing Address - Phone:859-512-4833
Mailing Address - Fax:
Practice Address - Street 1:1006 LEAWOOD DR
Practice Address - Street 2:SUITE #200
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-3349
Practice Address - Country:US
Practice Address - Phone:502-223-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist