Healthcare Provider Details

I. General information

NPI: 1346175676
Provider Name (Legal Business Name): JACOB MICHAEL THOMAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 IOWA ST
PERRY IA
50220-2413
US

IV. Provider business mailing address

1409 EVANS VIEW DR
ADEL IA
50003-1769
US

V. Phone/Fax

Practice location:
  • Phone: 515-465-2633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-10490
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: