Jacob A Deniakos, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

6439 Issued in LA

Practice address

300 S. Twining Street, BLDG 760
42D Medical Group
Maxwell Afb, AL 36112

Phone

(334) 953-8607

Fax

(334) 953-8607

NPI assigned

Aug 26, 2014

Sex

Male

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 AL

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

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

{
    "created_epoch": "1409011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440633600000",
    "number": "1679973879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S. TWINING STREET, BLDG 760",
            "address_2": "42D MEDICAL GROUP",
            "city": "MAXWELL AFB",
            "state": "AL",
            "postal_code": "36112",
            "telephone_number": "334-953-5143",
            "fax_number": "334-953-8607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S. TWINING STREET, BLDG 760",
            "address_2": "42D MEDICAL GROUP",
            "city": "MAXWELL AFB",
            "state": "AL",
            "postal_code": "36112",
            "telephone_number": "334-953-8607",
            "fax_number": "334-953-8607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENIAKOS",
        "first_name": "JACOB",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-26",
        "last_updated": "2015-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "LA",
            "license": "6439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wesley Edward Conn, MD
• Jamie Dale Cornett, O.D.
• James A Dauber, PT
• Hector F Davila, MD
• Shana Dawson, NP
• Marnie Smith Dillon, PSY.D.
• Tristan Eddy, PHARMD
• Daniel J Efraim, PHARM.D.
• Melissa Nash Everage, NURSE PRACTITIONER
• Alexandria Fava, DMD

• Dentist in Maxwell Afb, AL
• Providers in Maxwell Afb, AL by specialty
• Dentist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2015; 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.