Provider Demographics
NPI:1578450839
Name:MCGILES, JACOB (DMD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:MCGILES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2325
Mailing Address - Country:US
Mailing Address - Phone:217-370-8633
Mailing Address - Fax:
Practice Address - Street 1:4517 N ROCKWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3853
Practice Address - Country:US
Practice Address - Phone:309-688-0121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190361671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice