Organization
ROBERT B JACOB, DDS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT B JACOB DDS (PRESIDENT)
(858) 268-1006
Entity
Organization
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 STE 200, SAN DIEGO, CA 92111-2284
(858) 268-1006
(858) 268-5097
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
B25912
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B25912-01
—
CA
Enumeration date
10/07/2015
Last updated
10/07/2015
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