Provider Demographics
NPI:1841492626
Name:ARMANIOUS, JACOB L (DDS)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:L
Last Name:ARMANIOUS
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:PO BOX 265566
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32126-5566
Mailing Address - Country:US
Mailing Address - Phone:386-253-7276
Mailing Address - Fax:
Practice Address - Street 1:150 S PENINSULA DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-4490
Practice Address - Country:US
Practice Address - Phone:386-253-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0764345-00Medicaid