Andrea Jacobs, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8988 Issued in NC

Practice address

2029 Valleygate Dr
Ste 201
Fayetteville, NC 28304-3688

Phone

(910) 485-8884

NPI assigned

Jun 22, 2010

Sex

Female

Sole proprietor

Yes

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

Enrolled in NC

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ryan, James, Wiles, Patel & Olsen LLP

  dba Southeastern Dental Specialists

  • Dentist
  • Fayetteville, NC
  • NPI 1346473279
  Medicare reassignment NPD
• Ryan, James, Wiles, Patel & Olsen LLP

  dba Village Family Dental

  • Dentist
  • Saint Pauls, NC
  • NPI 1689788366
  NPD
• Ryan, James, Wiles, Patel & Olsen LLP

  dba Village Family Dental

  • Dentist
  • Fayetteville, NC
  • NPI 1750495693
  NPD (past)

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

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277164800000",
    "number": "1669793873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 VALLEYGATE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043757",
            "telephone_number": "910-485-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2029 VALLEYGATE DR",
            "address_2": "STE 201",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043688",
            "telephone_number": "910-485-8884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "ANDREA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-22",
        "last_updated": "2010-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "8988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shanay Jackson
• Shihad Jackson
• Vonetta Bethea Jackson, LCSWA
• Yakeesha Y Jackson
• Rebecca Sue Jacobs-Lopez, RBT
• Ashley Leigh Jacobs
• Christian Jacobs
• Esther Jacobs
• Leon Jacobs, M.ED
• Olivia Shea Jacobson, MA, CCC-SLP

• General Practice Dentistry in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2010; 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.