Lisa Susan Jacob, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

19077 Issued in TX

Practice address

2810 Dacy LN
Kyle, TX 78640-6322

Phone

(210) 233-7000

Fax

(512) 268-2253

NPI assigned

Jun 16, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

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.

• Barrio Comprehensive Family Health Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • San Antonio, TX
  • NPI 1902883739
  Medicare reassignment NPD
• Dell Children'S Medical Group

  • Pediatrics Physician
  • Austin, TX
  • NPI 1326072943
  Medicare reassignment NPD
• Barrio Comprehensive Family Health Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Boerne, TX
  • NPI 1104207208
  NPD
• Barrio Comprehensive Family Health Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • San Marcos, TX
  • NPI 1295601052
  NPD
• Dell Children'S Medical Group

  • Sleep Disorder Diagnostic Clinic/Center
  • Austin, TX
  • NPI 1124748249
  NPD

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1386688331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 BARBARA JORDAN BLVD STE 301",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787233078",
            "telephone_number": "512-324-9999",
            "fax_number": "512-324-0645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 DACY LN",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786406322",
            "telephone_number": "210-233-7000",
            "fax_number": "512-268-2253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Barbara Jordan Blvd",
            "address_2": "Suite 307",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787233077",
            "country_code": "US",
            "telephone_number": "512-324-9999 x87141",
            "fax_number": "512-324-0645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOB",
        "first_name": "LISA",
        "middle_name": "SUSAN",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "19077",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "19077",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "19077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rose Ingala, M.D.
• Mobina Iranshahi
• J&a Dental Partners
• Angela Ann Jackson, LCSW-S
• Cassandra Dale Jackson, APRN, FNP-C
• Bryan Joseph Jacobson, PT, DPT
• Christine U Jacobson, PT, DPT
• Naomi James, MD
• Alap R Jani, M.D.
• Alexandra D Jaranilla, RBT

• Pediatric Dentistry in Kyle, TX
• Providers in Kyle, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.