Provider Demographics
NPI:1124755202
Name:RENDON, JACOB ALEXANDER (DDS)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ALEXANDER
Last Name:RENDON
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 1:213 LYNN DR # 201
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77801-3322
Mailing Address - Country:US
Mailing Address - Phone:806-206-1339
Mailing Address - Fax:
Practice Address - Street 1:1509 EMERALD PKWY STE 105
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5502
Practice Address - Country:US
Practice Address - Phone:979-696-8681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38895122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist