Jessica Koster, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN29830 Issued in FL

Practice address

10 Saint Johns Medical Park Dr Ste C
St Augustine, FL 32086-5202

Phone

(210) 450-3715

NPI assigned

Jul 14, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 17, 2025 through Sep 17, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1508590647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 SHIPYARD WAY APT 1436",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320844233",
            "telephone_number": "214-608-8046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SAINT JOHNS MEDICAL PARK DR STE C",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865202",
            "telephone_number": "210-450-3715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTER",
        "first_name": "JESSICA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-14",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "38796",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN29830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Muhieddine Muhammad Koleilat, PHARMACIST
• John S Koppman, M.D.
• Cornelia Korey, LMT
• S Graham Kosch, PHD
• Felice I Koscinski, MD
• Sara L Kouten, LCSW
• Tracy L Kozak, AP
• Dawn E Kpelo
• Dumbor G Kpelo
• Katrinia L Kraemer, FNP

• Periodontics in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.