Jacob Orth Sisombath, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

25064 Issued in TX

Practice address

2020 N Masters Dr
Dallas, TX 75217-3168

Phone

(972) 285-2600

NPI assigned

May 14, 2008

Last updated

Sep 13, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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 TX

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

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.

• Mini Apple Dental Enterprise PLLC

  • Dentist
  • Fort Worth, TX
  • NPI 1851773857
  NPD (past) Authorized official

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

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347494400000",
    "number": "1710154224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 N MASTERS DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752173168",
            "telephone_number": "972-285-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 N MASTERS DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752173168",
            "telephone_number": "972-285-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISOMBATH",
        "first_name": "JACOB",
        "middle_name": "ORTH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-14",
        "last_updated": "2012-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "25064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Sirri, MD
• Deepa Sirsi, MD
• Jessica Danielle Sisco, MD
• Jacqueline Marie Sisk, OTR
• Matthew Robert Siskowski, MD
• Stephen Charles Sissons, RN
• Emily Siswanto, PHARMD
• Stefanus H Siswanto, DDS
• Amreen Sitabkhan
• Amy Sitabkhan, OTR

• General Practice Dentistry in Dallas, TX
• Providers in Dallas, 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 Sep 13, 2012; 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.