=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457574048
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACK T. KRAUSER DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 10/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1499 W PALMETTO PARK RD STE.302
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33486-3328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-392-4747
-----------------------------------------------------
Fax | 561-392-8320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1499 W PALMETTO PARK RD STE.302
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33486-3328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-392-4747
-----------------------------------------------------
Fax | 561-392-8320
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | DN7727
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | DN7727
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------