ROBERT B JACOB (NPI# 1215093315) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215093315 |
| Entity Type | Individual |
| Full Name | ROBERT B JACOB |
| Credential | D.D.S. |
| Practice Address |
4617 Ruffner St Ste 200 San Diego CA 92111-2284 |
| Mailing Address |
4617 Ruffner St Suite 200 San Diego CA 92111-2285 |
| Practice Telephone | 8582681006 |
| Practice Fax Number | 8582685097 |
| Mailing Telephone | 8582681006 |
| Mailing Fax Number | 8582685097 |
| Enumeration Date | 2006-12-31 |
| Last Update Date | 2010-02-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
B 25912 | CA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | B25912-01 | 05 | |
| CA | STATE DENTAL LICENSE | 25912 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497105605 | Robert Jacob | Physician Assistant | 180 Kennedy Memorial Dr Ste 201, Waterville, ME 04901-4541 | 2016-06-18 |
| 1790709483 | Robert A Jacob | Orthopaedic Surgery | 1900 Bluegrass Ave, Suite 300, Louisville, KY 40215-1144 | 2006-07-26 |
| 1023017498 | Robert S Jacob | Anesthesiology | 2139 Auburn Ave, Cincinnati, OH 45219-2906 | 2005-07-19 |
| Street Address |
4617 RUFFNER ST STE 200 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92111-2284 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992175699 | Robert B Jacob, Dds, Inc | Clinic/Center | 4617 Ruffner St Ste 200, San Diego, CA 92111-2284 | 2015-10-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982220653 | Karen Elizabeth Mitchell | Registered Nurse | County of San Diego California Children's Services (ccs, 6991 Balboa Ave, (room 70), San Diego, CA 92111 | 2020-06-18 |
| 1912523804 | Access Medical, Inc. | Durable Medical Equipment & Medical Supplies | 4150 Convoy Street, Suite A, San Diego, CA 92111 | 2020-06-17 |
| 1154944551 | Mei Ling Milan Szeto | Student in an Organized Health Care Education/Training Program | 7917 Ostrow Street, Suite A, San Diego, CA 92111 | 2020-05-20 |
| 1346893831 | Leticia Isabel Peralta | Assistant Behavior Analyst | 563 Balboa Avenue. Number 521, San Diego, CA 92111 | 2019-07-23 |
| 1295204394 | Demetria Serfas | Behavioral Analyst | 563 Balboa Ave #521, San Diego, CA 92111 | 2018-11-19 |
| 1568981678 | Ross Psychology | Psychologist | 4883 Ronson Court, Suite K, San Diego, CA 92111 | 2017-09-11 |
| 1225554587 | Bianca Acosta | Technician, Other | 563 Balboa Ave. #521, San Diego, CA 92111 | 2017-08-18 |
| 1194240085 | Kazuhiro Kato | Dentist | 3707 Convoy St., San Diego, CA 92111 | 2017-08-11 |
| 1073038527 | Joanne Epps-yentz | Licensed Vocational Nurse | 7414 Mesa College Dr. Apt 47, San Diego, CA 92111 | 2017-08-06 |
| 1184158446 | Positive Behavior Supports Corp | Community/Behavioral Health | 563 Balboa Ave, 521, San Diego, CA 92111 | 2017-04-13 |
| Find all providers in zip 92111 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295210920 | Hiba Alabdullah | Dentist | 6482 Ambrosia Dr Apt 5106, San Diego, CA 92124-3143 | 2018-09-28 |
| 1548745300 | Cesar Augusto Manrique Moreno | Dentist | 1041 Market St Ste 165, San Diego, CA 92101-7233 | 2018-09-27 |
| 1902314834 | Jae Young Yoo | Dentist | 4765 Carmel Mountain Rd Ste 208, San Diego, CA 92130-6657 | 2018-01-12 |
| 1003326224 | Dr. Hoss, A Professional Corporation | Dentist | 11943 El Camino Real Ste 200, San Diego, CA 92130-2597 | 2017-10-02 |
| 1336668110 | Hoss Km Dental Group, A Professional Group | Dentist | 9737 Aero Dr, San Diego, CA 92123-1859 | 2017-09-13 |
| 1790136687 | Cheryl Kang Guerrero | Dentist | 3810 Valley Centre Dr Ste 902a, San Diego, CA 92130-3308 | 2016-06-22 |
| 1457748212 | Peter Mark Vrontikis | Dentist | 7777 Westside Dr Apt 469, San Diego, CA 92108-1242 | 2015-04-20 |
| 1568857464 | Dr. Jeffrey A. Saladin, Dental Corporation | Dentist | 4074 Fairmount Avenue, Suite B, San Diego, CA 92105 | 2015-03-30 |
| 1649522913 | Budd Email Rubin | Dentist | 1145 Pacific Beach Dr, #408, San Diego, CA 92109-5194 | 2012-10-10 |
| 1700165917 | Matthew Durschlag | Dentist | 239 Laurel St Ste 201, San Diego, CA 92101-1473 | 2011-08-05 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.