Provider Demographics
NPI:1770857856
Name:DEVINNEY, JACOB L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:L
Last Name:DEVINNEY
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 1:5000 PLEASANTON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7052
Mailing Address - Country:US
Mailing Address - Phone:949-400-5254
Mailing Address - Fax:925-484-0346
Practice Address - Street 1:5000 PLEASANTON AVE STE 110
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7052
Practice Address - Country:US
Practice Address - Phone:949-400-5254
Practice Address - Fax:925-484-0346
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice