Provider Demographics
NPI:1720685761
Name:HADLEY, JACOB KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:KENT
Last Name:HADLEY
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 1:547 S 1650 E
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2904
Mailing Address - Country:US
Mailing Address - Phone:801-735-5354
Mailing Address - Fax:
Practice Address - Street 1:4870 N ADAMS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-1415
Practice Address - Country:US
Practice Address - Phone:248-754-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417191122300000X
MI2901601183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist