Healthcare Provider Details

I. General information

NPI: 1619539384
Provider Name (Legal Business Name): JACOB D. WEISSICH, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 N FRESNO ST STE 104
FRESNO CA
93720-2408
US

IV. Provider business mailing address

7730 N FRESNO ST STE 104
FRESNO CA
93720-2408
US

V. Phone/Fax

Practice location:
  • Phone: 917-536-1011
  • Fax:
Mailing address:
  • Phone: 917-536-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB D. WEISSICH
Title or Position: OWNER DOCTOR
Credential: DDS
Phone: 559-431-9104