Jacob William Des Jardins

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D14942 Issued in MN

Practice address

4555 Erin Dr Ste 180
Eagan, MN 55122-3334

Phone

(651) 681-9044

NPI assigned

Apr 11, 2023

Last updated

May 31, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Minnesota Dental Professionals, P.C.

  • General Practice Dentistry
  • Eagan, MN
  • NPI 1114522992
  NPD
• Dr. Park Dental Office 1, LLC

  dba Clear Lakes Dental

  • General Practice Dentistry
  • Saint Paul, MN
  • NPI 1508594664
  NPD (past)

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

{
    "created_epoch": "1681171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717113600000",
    "number": "1154017432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4555 ERIN DR STE 180",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551223334",
            "telephone_number": "651-681-9044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4555 ERIN DR STE 180",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551223334",
            "telephone_number": "651-681-9044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DES JARDINS",
        "first_name": "JACOB",
        "middle_name": "WILLIAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-11",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denae Ruble LMFT LLC
• Sandra L Denman, MD
• Dental Specialists of Minnesota, PLLC (The Dental Specialists)
• Nicholas Dephillipo, ST, SA
• Dermatology Center for Children & Young Adults PA
• Karin Desrocher, D.C.
• Sandra Kaye Deutsch
• Missy Sue Dever, FNP-BC
• Diabetic Shoe Source
• Tayler Rae Dingmann, DDS

• General Practice Dentistry in Eagan, MN
• Providers in Eagan, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; 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.