Healthcare Provider Details

I. General information

NPI: 1609799360
Provider Name (Legal Business Name): JACOB DENT, D.D.S., NEW ORLEANS MODERN DENTISTRY, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2537 TULANE AVE
NEW ORLEANS LA
70119
US

IV. Provider business mailing address

PO BOX 660041
DALLAS TX
75266-0041
US

V. Phone/Fax

Practice location:
  • Phone: 504-569-5513
  • Fax: 504-267-2572
Mailing address:
  • Phone: 714-845-8890
  • Fax: 303-952-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JACOB DENT
Title or Position: OWNER
Credential: DDS
Phone: 504-569-5513