| Robert B Jacob, Dds, Inc | |
|
4617 Ruffner St Ste 200 San Diego CA 92111-2284 | |
| (858) 268-1006 | |
| (858) 268-5097 |
| Full Name | Robert B Jacob, Dds, Inc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4617 Ruffner St Ste 200, San Diego, California |
| Authorized Official Name and Position | Robert B Jacob (PRESIDENT) |
| Authorized Official Contact | 8582681006 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert B Jacob, Dds, Inc 4617 Ruffner St Ste 200 San Diego CA 92111-2284 Ph: (858) 268-1006 | Robert B Jacob, Dds, Inc 4617 Ruffner St Ste 200 San Diego CA 92111-2284 Ph: (858) 268-1006 |
| NPI Number | 1992175699 |
|---|---|
| Provider Enumeration Date | 10/07/2015 |
| Last Update Date | 10/07/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992175699 | NPI | - | NPPES |
| B25912-01 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | B25912 (California) | Primary |
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