Provider Demographics
NPI:1174723621
Name:JACOBO, PABLO (DDS)
Entity type:Individual
Prefix:DR
First Name:PABLO
Middle Name:
Last Name:JACOBO
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 1:1035 W ROBINHOOD DR
Mailing Address - Street 2:SUITE #200
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5621
Mailing Address - Country:US
Mailing Address - Phone:209-952-3687
Mailing Address - Fax:209-952-6267
Practice Address - Street 1:1035 W ROBINHOOD DR
Practice Address - Street 2:SUITE #200
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5621
Practice Address - Country:US
Practice Address - Phone:209-952-3687
Practice Address - Fax:209-952-6267
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist