Jacob Roper, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11788 Issued in OR

Practice address

1825 NW Hawthorne Ave
Grants Pass, OR 97526-1043

Phone

(541) 479-6623

NPI assigned

Apr 29, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Lolo Dental Clinic PC

  • General Practice Dentistry
  • Lolo, MT
  • NPI 1629133186
  NPD (past)

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

{
    "created_epoch": "1619654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1982287892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1242 NW SALISBURY DR",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975266349",
            "telephone_number": "801-946-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 NW HAWTHORNE AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261043",
            "telephone_number": "541-479-6623"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 Tyler Way",
            "address_purpose": "LOCATION",
            "city": "Lolo",
            "state": "MT",
            "postal_code": "598479714",
            "country_code": "US",
            "telephone_number": "406-273-0490",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2901 Brooks St Ste A1",
            "address_purpose": "LOCATION",
            "city": "Missoula",
            "state": "MT",
            "postal_code": "598017723",
            "country_code": "US",
            "telephone_number": "406-541-2886",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROPER",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-29",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MT",
            "license": "21493",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Romaine
• Jorge Romero
• Randy E Romero, RRT
• Laura Lynn Rommes, PHARM-D
• Mark Allen Rondeau, M.D.
• Andromida Rosado
• Luis Angel Rosado
• Tony James Rosales, NP
• Arianne Daphne Allado Rosca, PT, DPT
• Leslie Jayne Rose, PEER SPECIALIST

• General Practice Dentistry in Grants Pass, OR
• Providers in Grants Pass, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.