NPIMap

Individual provider Active NPI

Jacob David Cragun, DDS, MS

  • Endodontics
  • Frisco, TX
National Provider Identifier
1124282207
Registry record updated Sep 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
25238 Issued in TX
Practice address
5858 W. Main St.
Suite 290
Frisco, TX 75034
Phone
(310) 902-7822
NPI assigned
Jul 17, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 679 FL
Endodontics 1223E0200X 25238 TX Primary

Addresses

Primary practice location

5858 W. Main St.
Suite 290
Frisco, TX 75034

Mailing address

5858 W. Main St.
Suite 290
Frisco, TX 75034
Phone (310) 902-7822

Other names 1

  • Dr. Jake David Cragun Other name

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
679FLMDEndodontist
25238TXMDEndodontist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346976000000",
    "number": "1124282207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5858 W. MAIN ST.",
            "address_2": "SUITE 290",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "75034",
            "telephone_number": "310-902-7822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5858 W. MAIN ST.",
            "address_2": "SUITE 290",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "75034",
            "telephone_number": "310-902-7822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAGUN",
        "first_name": "JACOB",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-17",
        "last_updated": "2012-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "FL",
            "license": "679",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "TX",
            "license": "25238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAKE",
            "last_name": "CRAGUN",
            "middle_name": "DAVID",
            "prefix": "DR.",
            "credential": "D.D.S",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Frisco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.