Robert B Jacob, D.D.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

B 25912 Issued in CA

Practice address

4617 Ruffner St Ste 200
San Diego, CA 92111-2284

Phone

(858) 268-1006

Fax

(858) 268-5097

NPI assigned

Dec 31, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Robert B Jacob, DDS, Inc

  • Dental Clinic/Center
  • San Diego, CA
  • NPI 1992175699
  NPD (past) Authorized official

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

{
    "created_epoch": "1167523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266192000000",
    "number": "1215093315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4617 RUFFNER ST",
            "address_2": "SUITE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921112285",
            "telephone_number": "858-268-1006",
            "fax_number": "858-268-5097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4617 RUFFNER ST STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921112284",
            "telephone_number": "858-268-1006",
            "fax_number": "858-268-5097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "ROBERT",
        "middle_name": "B",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-31",
        "last_updated": "2010-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "B 25912",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B25912-01",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE DENTAL LICENSE",
            "identifier": "25912",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacob Health Care Center LP
• Sharon Jacob-Soo, MD
• Christopher Alan Jacob, PA-C
• Jessica Marie Jacob, LMFT
• Katherine A Jacob
• Simon Jacob
• Tamra Jacob, RN
• Jacobi Medical Center
• Emily Jacobo
• Jacqueline Natalie Jacobo

• Orthodontics and Dentofacial Orthopedics Dentistry in San Diego, CA
• Providers in San Diego, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2010; 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.