Jacob A Powell, D.D.S., M.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

D-4232 Issued in ID

Practice address

101 Bodin Cir
Travis Afb, CA 94535

Phone

(707) 423-7000

NPI assigned

Jun 24, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1245801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747180800000",
    "number": "1376771733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BODIN CIRCLE",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351800",
            "telephone_number": "707-423-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "94535",
            "telephone_number": "707-423-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWELL",
        "first_name": "JACOB",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-24",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-4232",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "ID",
            "license": "D-4232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jakub Pietrowski, DDS
• Collins Pivadga
• Austin Ryder Podratz, PA-C
• Briana Polk, DMD
• Humayun Mohammed Popal, FNP
• Jackson Prestwood, MD
• Shawn Price
• Albi Qeli, M.D.
• Gema Argentina Raasch
• Sheela Rajan, M.D.

• Orthodontics and Dentofacial Orthopedics Dentistry in Travis Afb, CA
• Providers in Travis Afb, 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 May 14, 2025; 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.