Healthcare Provider Details

I. General information

NPI: 1740127232
Provider Name (Legal Business Name): JACOB ANDREW DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7019 W HEFNER RD
OKLAHOMA CITY OK
73162-4712
US

IV. Provider business mailing address

7019 W HEFNER RD
OKLAHOMA CITY OK
73162-4712
US

V. Phone/Fax

Practice location:
  • Phone: 405-832-3660
  • Fax:
Mailing address:
  • Phone: 405-832-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8168
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: