Provider Demographics
NPI:1932208881
Name:JACOB, ERIC S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:JACOB
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 1:2495 NAVY PL
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4812
Mailing Address - Country:US
Mailing Address - Phone:516-679-6899
Mailing Address - Fax:
Practice Address - Street 1:70 GLEN COVE RD
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1726
Practice Address - Country:US
Practice Address - Phone:516-621-1788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0481071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice