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Organization
PABLO JACOBO DDS, INC
Active
Organization
PABLO JACOBO DDS, INC
Active
Other names
Gotta Smile Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARLOS JACOBO (MANAGER)
(209) 952-3687
Entity
Organization
Contact information
Practice address
1035 W ROBINHOOD DR, SUITE 200, STOCKTON, CA 95207-5621
(209) 952-3687
(209) 952-6267
Mailing address
1035 W ROBINHOOD DR, SUITE 200, STOCKTON, CA 95207-5621
(209) 952-3687
(209) 952-6267
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
100679
CA
122300000X
Dentist
61240
CA
1223G0001X
General Practice Dentistry
Primary
38433
CA
1223G0001X
General Practice Dentistry
60929
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100679
CA DENTAL BOARD
CA
01
—
38433
CA DENTAL STATE BOARD
CA
01
—
60929
CA DENTAL STATE BOARD
CA
01
—
61240
CA DENTAL BOARD
CA
Enumeration date
05/02/2012
Last updated
09/20/2016
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