Pablo Jacobo DDS, Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

38433 Issued in CA

Legal business name

PABLO JACOBO DDS, INC

Practice address

1035 W Robinhood Dr
Suite 200
Stockton, CA 95207-5621

Phone

(209) 952-3687

Fax

(209) 952-6267

NPI assigned

May 2, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Carlos Jacobo

Title

Manager

Phone

(209) 952-3687

Specialties & licenses 4

Addresses

Other identifiers 4

Other names 1

• Gotta Smile Dentistry Former legal business name

Tax ID family

Gotta Smile Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pablo Jacobo DDS Inc

  dba Gotta Smile Dentistry

  • Dentist
  • Stockton, CA
  • NPI 1235500455
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Uriel Badillo Centeno, DDS

  • Dentist
  • Stockton, CA
  • NPI 1518469550
  NPD (past)
• Pablo Jacobo, DDS

  • Dentist
  • Stockton, CA
  • NPI 1174723621
  NPD (past)

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

{
    "created_epoch": "1335916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474329600000",
    "number": "1508124074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 W ROBINHOOD DR",
            "address_2": "SUITE 200",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075621",
            "telephone_number": "209-952-3687",
            "fax_number": "209-952-6267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 W ROBINHOOD DR",
            "address_2": "SUITE 200",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075621",
            "telephone_number": "209-952-3687",
            "fax_number": "209-952-6267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PABLO JACOBO DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-02",
        "last_updated": "2016-09-20",
        "status": "A",
        "authorized_official_last_name": "JACOBO",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "209-952-3687",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "61240",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "100679",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "38433",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "60929",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA DENTAL STATE BOARD",
            "identifier": "38433",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA DENTAL BOARD",
            "identifier": "61240",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA DENTAL STATE BOARD",
            "identifier": "60929",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA DENTAL BOARD",
            "identifier": "100679",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gotta Smile Dentistry",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kimberly Castillo Pabaira
• Gurneet Kaur Pabla
• Harleen S Pabla
• Shiellla Pablico
• Pablo Jacobo DDS Inc (Gotta Smile Dentistry)
• Cesar Cosme Pabustan, M.D.
• Alyssa Pacheco
• Bessy Varinia Pacheco
• Gustavo Pacheco Jr.
• Moses Pacheco III

• General Practice Dentistry in Stockton, CA
• Providers in Stockton, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2016; 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.