Provider Demographics
NPI:1972485423
Name:EDER, JACOB (DMD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:EDER
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 1:1460 MARVIN GARDENS LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5538
Mailing Address - Country:US
Mailing Address - Phone:928-848-2888
Mailing Address - Fax:
Practice Address - Street 1:2777 E CAMELBACK RD STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4348
Practice Address - Country:US
Practice Address - Phone:602-737-3624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD012579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist