Legacy Smiles of San Juan PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LEGACY SMILES OF SAN JUAN PLLC

Practice address

826 W US Highway 83 Ste B
San Juan, TX 78589-2141

Phone

(956) 475-3005

Fax

(956) 475-3011

NPI assigned

Dec 6, 2023

Organization subpart

No

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

Authorized official

Name

Jerin Jacob, DDS

Title

Dentist Owner

Phone

(956) 574-4666

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1701820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1477320703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 W US HIGHWAY 83 STE B",
            "city": "SAN JUAN",
            "state": "TX",
            "postal_code": "785892141",
            "telephone_number": "956-475-3005",
            "fax_number": "956-475-3011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 W US HIGHWAY 83 STE B",
            "city": "SAN JUAN",
            "state": "TX",
            "postal_code": "785892141",
            "telephone_number": "956-475-3005",
            "fax_number": "956-475-3011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY SMILES OF SAN JUAN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-06",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "JERIN",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "956-574-4666",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in San Juan, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; 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.