Provider Demographics
NPI:1871511964
Name:JACOB, THORPE A (DMD)
Entity Type:Individual
Prefix:DR
First Name:THORPE
Middle Name:A
Last Name:JACOB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E GEORGIA ST
Mailing Address - Street 2:PO BOX 609
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-1953
Mailing Address - Country:US
Mailing Address - Phone:864-476-8315
Mailing Address - Fax:864-476-6150
Practice Address - Street 1:601 E GEORGIA ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-1953
Practice Address - Country:US
Practice Address - Phone:864-476-8315
Practice Address - Fax:864-476-6150
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice