Provider Demographics
NPI:1518205194
Name:JACOB, RHONDA (DMD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 NORTH LOOP W STE 230
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1082
Mailing Address - Country:US
Mailing Address - Phone:973-204-3014
Mailing Address - Fax:
Practice Address - Street 1:2525 NORTH LOOP W STE 230
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1082
Practice Address - Country:US
Practice Address - Phone:713-861-7216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist