Provider Demographics
NPI:1316736879
Name:JACOB A RENDON, D.D.S., P.C.
Entity type:Organization
Organization Name:JACOB A RENDON, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-206-1339
Mailing Address - Street 1:1509 EMERALD PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5502
Mailing Address - Country:US
Mailing Address - Phone:979-696-8681
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental