Individual
LISA SUSAN JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
2810 DACY LN, KYLE, TX 78640-6322
(210) 233-7000
(512) 268-2253
Mailing address
1301 BARBARA JORDAN BLVD STE 301, AUSTIN, TX 78723-3078
(512) 324-9999
(512) 324-0645
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
19077
TX
1223P0221X
Pediatric Dentistry
Primary
19077
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
19077
TX
Other
Enumeration date
06/16/2006
Last updated
09/11/2025
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