Provider Demographics
NPI:1508590647
Name:KOSTER, JESSICA (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:KOSTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SHIPYARD WAY APT 1436
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4233
Mailing Address - Country:US
Mailing Address - Phone:214-608-8046
Mailing Address - Fax:
Practice Address - Street 1:10 SAINT JOHNS MEDICAL PARK DR STE C
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5202
Practice Address - Country:US
Practice Address - Phone:210-450-3715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38796122300000X
FLDN298301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist