Provider Demographics
NPI:1912020140
Name:JACOB, MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2444 CIMMARON DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4714
Mailing Address - Country:US
Mailing Address - Phone:972-747-7499
Mailing Address - Fax:
Practice Address - Street 1:4431 W WALNUT ST STE A
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-4108
Practice Address - Country:US
Practice Address - Phone:972-998-5945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice