MEDICARE: BEN JACOBY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30.028056	OH

General Provider Information

NPI Number	:	1427943653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEN JACOBY DMD

Provider Business Mailing Address
First Line	:	1600 EUCLID AVE APT 1009
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2153
Country	:	US
Telephone Number	:	216-534-5955
Fax Number	:

Provider Business Practice Location Address
First Line	:	5507 MAYFIELD RD
Second Line	:
City	:	LYNDHURST
State	:	OH
Zip	:	44124-2913
Country	:	US
Telephone Number	:	440-473-3338
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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Directions to “ BEN JACOBY DMD” Practice Location

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