Jasmine Esmailzadegan, DMD
Individual provider Active NPI General Practice Dentistry · Saint Louis, MO
NPI 1013579010 · NPPES record last updated Oct 4, 2019
Key facts
- NPI
- 1013579010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2019022466 (MO)
- Practice address
- 200 S Kirkwood Rd Ste 90
Saint Louis, MO 63122-4351 - Phone
- (314) 858-1175
- NPI assigned
- Jul 1, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190927003110 | MO | Order and Referring Only - Dentist |
3779813092 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jeffrey J Harris DDS | Past |
Accepting new patients | |
| Alex Sharifian DDS Ofallon Modern Dentistry PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2019022466 | MO | Yes |
Addresses
Primary practice location
200 S Kirkwood Rd Ste 90
Saint Louis, MO 63122-4351
Mailing address
200 S Kirkwood Rd Ste 90
Saint Louis, MO 63122-4351
Phone (314) 858-1175
Other providers in Saint Louis, MO
- Azadeh Eslambolchi
- Azadeh Eslami Amin
- Brenda Kay Eslinger
- Rose Marie Eslinger
- Houri Esmaeil Khanian
- Suzan Hana Esmiel
- Christopher Brian Espana
- Gail Ann Esparza
- Jessica Espe
- Especial Needs, LLC
All providers in Saint Louis, MO · General Practice Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.