Individual
ROBERT B JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4617 RUFFNER ST STE 200, SAN DIEGO, CA 92111-2284
(858) 268-1006
(858) 268-5097
Mailing address
4617 RUFFNER ST, SUITE 200, SAN DIEGO, CA 92111-2285
(858) 268-1006
(858) 268-5097
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
B 25912
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25912
STATE DENTAL LICENSE
CA
05
—
B25912-01
—
CA
Enumeration date
12/31/2006
Last updated
02/15/2010
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