Healthcare Provider Details

I. General information

NPI: 1770783094
Provider Name (Legal Business Name): JACOB SYLVESTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16103 W 135TH ST
OLATHE KS
66062-1516
US

IV. Provider business mailing address

16103 W 135TH ST
OLATHE KS
66062-1516
US

V. Phone/Fax

Practice location:
  • Phone: 913-829-9222
  • Fax:
Mailing address:
  • Phone: 913-829-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60610
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2006024257
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: