Healthcare Provider Details

I. General information

NPI: 1679486773
Provider Name (Legal Business Name): JACOB YAGER DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9830 AUBURN RD STE 101
FORT WAYNE IN
46825-2464
US

IV. Provider business mailing address

9830 AUBURN RD STE 101
FORT WAYNE IN
46825-2464
US

V. Phone/Fax

Practice location:
  • Phone: 260-489-8435
  • Fax: 260-489-8535
Mailing address:
  • Phone: 260-489-8435
  • Fax: 260-489-8535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACOB YAGER
Title or Position: DENTIST
Credential: DDS
Phone: 260-489-8435