Active NPI
Jacob John, DDS
- Dentist
- Suffern, NY
National Provider Identifier
1235385055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 054091
- Practice address
- 156 Route 59 Ste A1
Suffern, NY 10901-5013 - Phone
- (845) 356-8844
- Fax
- (845) 547-2218
- NPI assigned
- Aug 12, 2008
- Last updated
- Mar 27, 2026
- 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 | 054091 | NY | Primary |
Addresses
Primary practice location
156 Route 59 Ste A1
Suffern, NY 10901-5013
Mailing address
9 Dunmore Rd
New City, NY 10956-4407
Phone (917) 742-3081
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 054091 | Other | NY | NEW YORK STATE DENTAL LICENSE |
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 |
|---|---|---|---|
| 054091 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ident Dental at Suffern | Past | Accepting new patients | |
| Exceldent Dental of Western Sullivan LLP | Dentist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Dentist
- Liberty, NY
- NPI 1245529874
-
- General Practice Dentistry
- Suffern, NY
- NPI 1033541552
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774569600000",
"number": "1235385055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 DUNMORE RD",
"city": "NEW CITY",
"state": "NY",
"postal_code": "109564407",
"telephone_number": "917-742-3081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "156 ROUTE 59 STE A1",
"city": "SUFFERN",
"state": "NY",
"postal_code": "109015013",
"telephone_number": "845-356-8844",
"fax_number": "845-547-2218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHN",
"first_name": "JACOB",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-12",
"last_updated": "2026-03-27",
"certification_date": "2026-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "054091",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK STATE DENTAL LICENSE",
"identifier": "054091",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Suffern, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.