Healthcare Provider Details

I. General information

NPI: 1285085175
Provider Name (Legal Business Name): JEENA PRIYA KRISHNA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEENA PRIYA KRISHNA

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PROGRESS PKWY
SULLIVAN MO
63080-2359
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax:
Mailing address:
  • Phone: 844-853-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2022000017
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: