Provider Demographics
NPI:1225359003
Name:JACOB, LORRAINE VINITHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:VINITHA
Last Name:JACOB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23219 SPRUCE FALLS CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3523
Mailing Address - Country:US
Mailing Address - Phone:832-594-8291
Mailing Address - Fax:
Practice Address - Street 1:23219 SPRUCE FALLS CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3523
Practice Address - Country:US
Practice Address - Phone:832-594-8291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00255981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice