Provider Demographics
NPI:1558934612
Name:JALOWY, JAKOB JORDAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAKOB
Middle Name:JORDAN
Last Name:JALOWY
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 1:5402 HICKORY HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4088
Mailing Address - Country:US
Mailing Address - Phone:979-257-6040
Mailing Address - Fax:
Practice Address - Street 1:901 CLUBSIDE DR
Practice Address - Street 2:
Practice Address - City:EAST BERNARD
Practice Address - State:TX
Practice Address - Zip Code:77435-8759
Practice Address - Country:US
Practice Address - Phone:979-335-4825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX375621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice