Provider Demographics
NPI:1518656818
Name:YOKLEY, JACOB TANNER (DMD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:TANNER
Last Name:YOKLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 JENNINGS STATION RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-3500
Mailing Address - Country:US
Mailing Address - Phone:314-382-2000
Mailing Address - Fax:
Practice Address - Street 1:3708 JENNINGS STATION RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-3500
Practice Address - Country:US
Practice Address - Phone:314-382-2000
Practice Address - Fax:314-382-2411
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023021217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist