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General NPI Number Information
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NPI Number | 1003709676
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Entity Type | Organization
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Legal Business Name | JACOB DENT DDS ELMWOOD MODERN DENTISTRY A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 1208 S CLEARVIEW PKWY STE C
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City | HARAHAN
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State | LA
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Zip | 70123-2557
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Country | US
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Telephone | 504-224-9093
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 660041
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City | DALLAS
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State | TX
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Zip | 75266-0041
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACOB DENT
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Credential |
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Telephone | 714-845-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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