Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Stacy Jacob, DMD

Individual provider General Practice Dentistry · NPI 1275150013

Stacy Jacob, DMD is a General Practice Dentistry in Lakewood, Ohio. Practices as a sole proprietor. Licensed in Ohio.

Licensed in
OH
In the registry since
2020
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

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Practice location Address checks out

15711 Madison Ave Ste 104
Lakewood, OH 44107-5655
Phone: (216) 228-7950
Fax: (216) 228-7951
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence 30.026177 (OH)

Record details

NPI number1275150013
Entity typeIndividual (Type 1)
GenderFemale
Credentials DMD
Sole proprietorYes
NPI enumeratedJune 27, 2020
Last updated in NPPESJune 27, 2020
Certification dateJune 27, 2020
Mailing address15711 Madison Ave Ste 104, Lakewood, OH 44107-5655

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