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General NPI Number Information
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NPI Number | 1891294807
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF KENTUCKY, COLLEGE OF DENTISTRY
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 02/06/2018
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Provider Practice Location Address
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Address Line | 800 ROSE ST UK CHANDLER HOSPITAL, DENTAL WING, ORTHODONTICS
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City | LEXINGTON
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State | KY
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Zip | 40536
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Country | US
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Telephone | 859-323-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 800 ROSE ST UK CHANDLER HOSPITAL, DENTAL WING, ORTHODONTICS
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City | LEXINGTON
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State | KY
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Zip | 40536-7001
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Country | US
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Telephone | 859-323-3368
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST/RESIDENT
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Name | DR. GEORGE JERYN JACOB
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Credential | BDS, MDS
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Telephone | 859-323-5655
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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 | 9682
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License Number State | KY
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