Provider Demographics
NPI:1861478810
Name:JACOB, HUBERT JOSEPH JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUBERT
Middle Name:JOSEPH
Last Name:JACOB
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BERT
Other - Middle Name:J
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 488018
Mailing Address - Street 2:7554 BRIDGETOWN RD
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-8018
Mailing Address - Country:US
Mailing Address - Phone:513-941-1907
Mailing Address - Fax:513-941-1910
Practice Address - Street 1:7554 BRIDGETOWN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-2015
Practice Address - Country:US
Practice Address - Phone:513-941-1907
Practice Address - Fax:513-941-1910
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice