MEDICARE: JACOB SONN DMD LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1437933140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACOB SONN DMD LLC

Provider Business Mailing Address
First Line	:	934 QUANAL CT
Second Line	:
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-2824
Country	:	US
Telephone Number	:	904-501-3556
Fax Number	:

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	:	OWNER
Name	:	DR. JACOB SONN
Credential	:	DMD
Telephone Number	:	904-501-3556

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

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