Healthcare Provider Details

I. General information

NPI: 1174906242
Provider Name (Legal Business Name): JACOB EARL SONN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 WATSON RD STE 101
SAINT LOUIS MO
63126-2217
US

IV. Provider business mailing address

9000 WATSON RD STE 101
SAINT LOUIS MO
63126-2217
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-7500
  • Fax: 314-842-8401
Mailing address:
  • Phone: 314-842-7500
  • Fax: 314-842-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 21412
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20117002646
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: