| Organization Name: | DR. JACOB ATKINSON DMD PC |
| NPI Number: | 1700039518 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JACOB ATKINSON (PRESIDENT) |
| Mailing Address: | 130 Court St S Vale |
| State: | OR US |
| Postal Code: | 979181326 |
| Phone Number: | 5414739166 |
| Fax Number: | |
| NPI Enumeration Date: | 10/24/2008 |
| NPI Last Update Date: | 10/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | D9126 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |