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General NPI Number Information
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NPI Number | 1528455268
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Entity Type | Individual
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Provider Name | JAKE JACOMET DDS
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Gender | Male
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 634B FAIRVIEW RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-6700
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Country | US
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Telephone | 864-962-8767
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Fax |
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Provider Business Mailing Address
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Address Line | 127 J MOORE AVE
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City | TOWNVILLE
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State | SC
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Zip | 29689-3851
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Country | US
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Telephone | 414-426-3532
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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 | 8773
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License Number State | SC
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