Provider Demographics
NPI:1366597890
Name:DENT, JACOB RYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:RYAN
Last Name:DENT
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 1:20911 LONELY STAR LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-7043
Mailing Address - Country:US
Mailing Address - Phone:832-222-2324
Mailing Address - Fax:
Practice Address - Street 1:3807 FM 1092 RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2223
Practice Address - Country:US
Practice Address - Phone:281-499-1618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229671223G0001X
LA55351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice