Zachary Michael Jacobs, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.033963 Issued in IL

Practice address

5116 N Big Hollow Rd Ste 101
Peoria, IL 61615-3514

Phone

(847) 730-9910

NPI assigned

Apr 5, 2022

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 2, 2023.

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682985600000",
    "number": "1700527678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532332186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5116 N BIG HOLLOW RD STE 101",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616153514",
            "telephone_number": "847-730-9910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "ZACHARY",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-05",
        "last_updated": "2023-05-02",
        "certification_date": "2023-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.033963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lissiamma Jacob, MD
• Nirmal Tom Jacob, MBBS
• Raji Jacob, MD
• Sarah Lynn Jacob, APRN, FNP-C
• Kaleb L. Jacobs, D.O.
• Renaldo A Jacques, M.D.
• Courtney M Jaegle, PA
• Asim K Jaffer, MD
• Nazish Hasan Jafri, D.D.S.
• Sarath Kumar Jaganathan Jaishankar, MD

• All providers in Peoria, IL
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 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.