Individual
DR. GREGG ANDREW JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
83 HANOVER RD STE 240, FLORHAM PARK, NJ 07932-1508
(973) 360-1100
(973) 360-1101
Mailing address
83 HANOVER RD STE 240, FLORHAM PARK, NJ 07932-1508
(973) 360-1100
(973) 360-1101
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
22DI02252800
NJ
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
054217-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
91001810700
—
NJ
Enumeration date
03/27/2007
Last updated
03/17/2018
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