David Jacobs

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901021531 Issued in MI

Practice address

22811 Greater Mack Ave
Suite L-10
Saint Clair Shores, MI 48080-2021

Phone

(586) 774-2400

NPI assigned

Jun 29, 2015

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 MI

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• David Jacobs DDS PLLC

  • Dental Clinic/Center
  • Saint Clair Shores, MI
  • NPI 1699438028
  NPD (past) Authorized official
• Jonathan H. Jacobs, DDS, PLLC

  • General Practice Dentistry
  • Saint Clair Shores, MI
  • NPI 1356951156
  NPD (past)

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

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435536000000",
    "number": "1750763512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22811 GREATER MACK AVE",
            "address_2": "SUITE L-10",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802021",
            "telephone_number": "586-774-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22811 GREATER MACK AVE",
            "address_2": "SUITE L-10",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802021",
            "telephone_number": "586-774-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-29",
        "last_updated": "2015-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901021531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jack Failla D.C.P.C.
• Jackie Placidi MSW, LMSW
• N'Gozi Sahrel Jackson
• Nija Jackson, RBT
• Tracee Louise Jackson, LPC
• Jonathan H Jacobs, D.D.S.
• Leah Michelle Jacobs, DDS
• Rita Saleem Jaddou, M.D.
• Sara Jajo
• Brittney James

• General Practice Dentistry in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 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.