Provider Demographics
NPI:1174559587
Name:JACOBSON, ZHIMON Y (DMD)
Entity type:Individual
Prefix:DR
First Name:ZHIMON
Middle Name:Y
Last Name:JACOBSON
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 1:96 BAY STATE RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1906
Mailing Address - Country:US
Mailing Address - Phone:617-424-1919
Mailing Address - Fax:
Practice Address - Street 1:96 BAY STATE RD
Practice Address - Street 2:SUITE #1
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1906
Practice Address - Country:US
Practice Address - Phone:617-424-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA149431223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics