Provider Demographics
NPI:1083152490
Name:JACOB DENT DDS DENTISTS OF SLIDELL A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JACOB DENT DDS DENTISTS OF SLIDELL A PROFESSIONAL CORPORATION
Other - Org Name:DENTISTS OF SLIDELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:DENT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-214-1540
Mailing Address - Street 1:17000 RED HILL AVENUE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614
Mailing Address - Country:US
Mailing Address - Phone:714-845-8500
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:420 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-214-1540
Practice Address - Fax:985-746-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty