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NPI Code Detail

MEDICARE: JENNIFER T. VAN DMD

MEDICARE: JENNIFER T. VAN DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN18003FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346447828
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER T. VAN DMD
Provider Business Mailing Address
First Line : 2704 CYPRESSWAY CT
Second Line :
City : ORLANDO
State : FL
Zip : 32825-8563
Country : US
Telephone Number : 954-483-8184
Fax Number :
Provider Business Practice Location Address
First Line : 2050 OLD HICKORY TREE RD
Second Line : SUITE I
City : SAINT CLOUD
State : FL
Zip : 34772-8926
Country : US
Telephone Number : 407-556-3969
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2007
Last Update Date : 04/16/2010

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