MEDICARE: DR. JACOB EARL SONN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	20117002646	MO
2	122300000X	Dentist	DN 21412	FL

General Provider Information

NPI Number	:	1174906242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB EARL SONN D.M.D.

Provider Business Mailing Address
First Line	:	9000 WATSON RD STE 101
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-2217
Country	:	US
Telephone Number	:	314-842-7500
Fax Number	:	314-842-8401

Provider Business Practice Location Address
First Line	:	9000 WATSON RD STE 101
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-2217
Country	:	US
Telephone Number	:	314-842-7500
Fax Number	:	314-842-8401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	08/23/2023

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