Provider Demographics
NPI:1548581937
Name:YOON, JESSICA K (DDS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:K
Last Name:YOON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:Y
Other - Last Name:HANNAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4055 LINDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3201
Mailing Address - Country:US
Mailing Address - Phone:314-495-8179
Mailing Address - Fax:
Practice Address - Street 1:4055 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108
Practice Address - Country:US
Practice Address - Phone:314-535-7701
Practice Address - Fax:314-535-0385
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010016296122300000X
MT2466122300000X
IN12011923A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist