Active NPI
Steven Gary Jacob, D.M.D
- Dentist
- Fort Wayne, IN
National Provider Identifier
1053570200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12010605A
- Practice address
- 7210 Maplecrest Rd
Fort Wayne, IN 46835-1892 - Phone
- (260) 485-5530
- Fax
- (260) 485-8344
- NPI assigned
- Jun 3, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12010605A | IN | Primary |
Addresses
Primary practice location
7210 Maplecrest Rd
Fort Wayne, IN 46835-1892
Mailing address
7210 Maplecrest Rd
Fort Wayne, IN 46835-1892
Phone (260) 485-5530
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12010605A | IN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Joseph E. Kinder D.D.S., PC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Fort Wayne, IN
- NPI 1265691414
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212451200000",
"number": "1053570200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7210 MAPLECREST RD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468351892",
"telephone_number": "260-485-5530",
"fax_number": "260-485-8344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7210 MAPLECREST RD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468351892",
"telephone_number": "260-485-5530",
"fax_number": "260-485-8344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "STEVEN",
"middle_name": "GARY",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-03",
"last_updated": "2008-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12010605A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.