Mykle A Jacobs, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2005012885 Issued in MO

Practice address

1587 Vernon Rd
Lagrange, GA 30240-4146

Phone

(706) 884-2655

Fax

(706) 883-7670

NPI assigned

Aug 20, 2006

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)

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 and National Provider Directory roles.

• West Ga Oral Surgery Associates, P.C.

  • Oral and Maxillofacial Pathology Dentistry
  • Lagrange, GA
  • NPI 1942403795
  NPD

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597104000000",
    "number": "1366557530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1587 VERNON RD",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404146",
            "telephone_number": "706-884-2655",
            "fax_number": "706-883-7670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1587 VERNON RD",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404146",
            "telephone_number": "706-884-2655",
            "fax_number": "706-883-7670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "MYKLE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MO",
            "license": "2005012885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Nanette Jackson, LPC, NCC, CSOTS
• John M Jackson Jr., DMD
• John Morgan Jackson III, DMD
• Tanisha Jackson
• Chloe Beall Jacobs, PA-C
• Richard Harris Jadick, DO
• Hannah Smith James
• Jasmine Naheed, MDPC, LLC
• Deborah Jenkins, LPC
• Myles Sidney Jerdan, MEDICAL DOCTOR

• Oral and Maxillofacial Surgery (Dentist) in Lagrange, GA
• Providers in Lagrange, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; 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.