Bennett Jacoby

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DT2112 Issued in HI

Practice address

2978 Haleko Rd
Ste a
Lihue, HI 96766-1379

Phone

(808) 202-2060

NPI assigned

Jun 1, 2007

Last updated

Nov 7, 2016By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in HI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bennett Jacoby DDS Ms Inc.

  • Case Management Agency
  • Lihue, HI
  • NPI 1346484094
  NPD (past) Authorized official

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478476800000",
    "number": "1235331273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 75407294",
            "address_2": "STE. A",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571861379",
            "telephone_number": "808-202-2060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2978 HALEKO RD",
            "address_2": "STE A",
            "city": "LIHUE",
            "state": "HI",
            "postal_code": "967661379",
            "telephone_number": "808-202-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBY",
        "first_name": "BENNETT",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-01",
        "last_updated": "2016-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "HI",
            "license": "DT2112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stefani Iwami, LMFT
• Kaiea Iwasaki, OD
• Chandley Jackson
• Michelle Leigh Jackson, R. D.
• Tad Jackson, MD
• Ashley Jean James, FNP-BC
• Janie H Yoo MD LLC (Kauai Eye Institute)
• Kalanikauleleiaiwi Ah Len Jardine, RBT
• Randall P Jaurequi, DDS
• Martha Jay, LCSW

• Periodontics in Lihue, HI
• Providers in Lihue, HI by specialty
• Periodontics in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.