Healthcare Provider Details

I. General information

NPI: 1356037626
Provider Name (Legal Business Name): JASMIN MONAI TUCKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JASMIN MONAI JOHNSON

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S BROADVIEW ST
CAPE GIRARDEAU MO
63703-5725
US

IV. Provider business mailing address

2584 WALDEN BLVD
CAPE GIRARDEAU MO
63701-7446
US

V. Phone/Fax

Practice location:
  • Phone: 573-339-1196
  • Fax:
Mailing address:
  • Phone: 817-729-0648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026026268
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: