Provider Demographics
NPI:1265616247
Name:DAUB, JACOB C (DDS, MS)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:C
Last Name:DAUB
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N99W14692 TWIN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6612
Mailing Address - Country:US
Mailing Address - Phone:414-418-3786
Mailing Address - Fax:
Practice Address - Street 1:W172N9723 DIVISION RD
Practice Address - Street 2:SUITE B
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4603
Practice Address - Country:US
Practice Address - Phone:262-255-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5821-0151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics