# DR. GREGG ANDREW JACOB

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1164540233
- **Gender:** Man
- **Credential:** D.M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 22DI02252800 | NJ | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 054217-1 | NY | — |

## Other

- **Enumeration date:** 03/27/2007
- **Last updated:** 03/17/2018