Provider Demographics
NPI:1780970855
Name:LINDA JACOB DDS, PLLC
Entity type:Organization
Organization Name:LINDA JACOB DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-908-3773
Mailing Address - Street 1:1150 N WATTERS RD
Mailing Address - Street 2:STE 104
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5508
Mailing Address - Country:US
Mailing Address - Phone:972-908-3773
Mailing Address - Fax:972-908-3776
Practice Address - Street 1:1150 N WATTERS RD
Practice Address - Street 2:STE 104
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5508
Practice Address - Country:US
Practice Address - Phone:972-908-3773
Practice Address - Fax:972-908-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty