Provider Demographics
NPI:1053518746
Name:PEDRAZA, JACOB (DMD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:PEDRAZA
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 1:19211 ROBIN PERCH LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3618
Mailing Address - Country:US
Mailing Address - Phone:813-924-0419
Mailing Address - Fax:
Practice Address - Street 1:2638 NARNIA WAY UNIT 102
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7321
Practice Address - Country:US
Practice Address - Phone:813-949-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist