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General NPI Number Information
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NPI Number | 1013890284
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Entity Type | Individual
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Provider Name | JACOB ALLEN ENJATI DDS
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Gender | Male
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 24647 LAWTON AVE
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City | LOMA LINDA
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State | CA
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Zip | 92354-3323
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Country | US
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Telephone | 509-990-3031
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Fax |
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Provider Business Mailing Address
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Address Line | 24647 LAWTON AVE
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City | LOMA LINDA
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State | CA
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Zip | 92354-3323
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Country | US
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Telephone | 509-990-3031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 112095
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License Number State | CA
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