Lisa Susan Jacob, D.D.S.
Dentist, Pediatric Dentistry in Kyle, TX. Individual provider (NPI-1).
NPI number1386688331
StatusActive
Last updated in NPPESSep 11, 2025
Details
- NPI
- 1386688331
- Entity type
- Individual (NPI-1)
- Name
- Lisa Susan Jacob
- Credential
- D.D.S.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 16, 2006
- Certification date
- Sep 11, 2025
- Last updated
- Sep 11, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - ORAL SURGERY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0221X | Dentist, Pediatric Dentistry | 19077 | TX | Yes |
| 122300000X | Dentist | 19077 | TX | |
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 19077 | TX |
Practice location
2810 Dacy LnKyle, TX 78640-6322
Phone 210-233-7000 · Fax 512-268-2253
Mailing address
1301 Barbara Jordan Blvd Ste 301Austin, TX 78723-3078
Phone 512-324-9999 · Fax 512-324-0645
Other practice locations
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Pediatric Dentistry providers in Kyle, TX
- Alexandra Anyen Chen, DDS, MSNPI 1407417959
- Children'S Dentistry Of KyleNPI 1588895692
- Kids Dental WorksNPI 1598113953
- Kids Tooth Team Kyle, PLLCNPI 1851029581
- Kyle Pediatric DentalNPI 1679975932
All 6 Pediatric Dentistry providers in Kyle · All 1,070 providers in Kyle
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