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General NPI Number Information
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NPI Number | 1073249983
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Entity Type | Individual
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Provider Name | SHARON ANITHA JACOB DMD
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Gender | Female
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 181 CRAWFORD BLVD STE 112
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City | BOCA RATON
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State | FL
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Zip | 33432-3743
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Country | US
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Telephone | 561-430-3629
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Fax |
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Provider Business Mailing Address
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Address Line | 639 E OCEAN AVE STE 409
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-5017
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Country | US
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Telephone | 561-735-6553
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN27112
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License Number State | FL
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