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General NPI Number Information
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NPI Number | 1518089432
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Entity Type | Individual
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Provider Name | ABY A JACOB D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/30/2012
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Provider Practice Location Address
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Address Line | 6504 HIGHWAY 78 SUITE 146
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City | SACHSE
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State | TX
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Zip | 75048-3259
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Country | US
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Telephone | 972-530-3644
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Fax | 972-530-3655
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Provider Business Mailing Address
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Address Line | 1012 W HEBRON PKWY SUITE 108
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City | CARROLLTON
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State | TX
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Zip | 75010-1122
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Country | US
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Telephone | 972-939-6500
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Fax | 972-939-5300
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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 | 20704
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License Number State | TX
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