Neville Kallarackel Jacob, BDS,DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9859 Issued in KY

Practice address

4420 Dixie Hwy Ste 110
Louisville, KY 40216-2986

Phone

(502) 447-3323

Fax

(913) 752-9116

NPI assigned

Dec 24, 2009

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 KY

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": "1261612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504569600000",
    "number": "1811226715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7517 CELEBRATION WAY",
            "city": "CRESTWOOD",
            "state": "KY",
            "postal_code": "40014",
            "telephone_number": "317-702-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 DIXIE HWY STE 110",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402162986",
            "telephone_number": "502-447-3323",
            "fax_number": "913-752-9116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "NEVILLE",
        "middle_name": "KALLARACKEL",
        "name_prefix": "Dr.",
        "credential": "BDS,DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-24",
        "last_updated": "2017-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "9859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Dee Jackson, M.D.
• Tara Jackson
• Tyrza Nicole Jackson, BS, RBT
• Gabrielle Bella Oropilla Jacob, MD
• Kevin Jacob, BS
• Robert A Jacob, M.D.
• Amelia C. Jacobs, D.M.D.
• Bethany Jacobs
• Erica Jacobs
• Genevieve Camilla Jacobs, D.O.

• General Practice Dentistry in Louisville, KY
• Providers in Louisville, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2017; 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.