Provider Demographics
NPI:1881808293
Name:JACOB, RONALD F (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:F
Last Name:JACOB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 OLD KINGS ROAD NORTH
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137
Mailing Address - Country:US
Mailing Address - Phone:386-445-6111
Mailing Address - Fax:386-445-0219
Practice Address - Street 1:29 OLD KINGS ROAD NORTH
Practice Address - Street 2:SUITE 1-A
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137
Practice Address - Country:US
Practice Address - Phone:386-445-6111
Practice Address - Fax:386-445-0219
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist