Provider Demographics
NPI:1164059408
Name:ROUNDS, JACOB ROY (DDS)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ROY
Last Name:ROUNDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 N 200 E STE 9
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2382
Mailing Address - Country:US
Mailing Address - Phone:435-752-8000
Mailing Address - Fax:
Practice Address - Street 1:1260 N 200 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-7560
Practice Address - Country:US
Practice Address - Phone:435-752-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11847736-89031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice