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General NPI Number Information
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NPI Number | 1508094608
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Entity Type | Individual
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Provider Name | TERESA JACOB D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 02/20/2015
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Provider Practice Location Address
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Address Line | 308 CALLAHAN RD
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-7739
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Country | US
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Telephone | 401-295-9706
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Fax | 401-295-0920
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Provider Business Mailing Address
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Address Line | PO BOX 312
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City | PASCOAG
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State | RI
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Zip | 02859-0312
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Country | US
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Telephone | 401-567-0800
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Fax | 401-567-0900
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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 | LD00046
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License Number State | RI
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