=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518354620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERIC J CLAESSENS DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2015
-----------------------------------------------------
Last Update Date | 04/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12450 TAMIAMI TRL S UNIT A
-----------------------------------------------------
City | NORTH PORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34287-1473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-423-1777
-----------------------------------------------------
Fax | 941-423-0493
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12450 TAMIAMI TRL S UNIT A
-----------------------------------------------------
City | NORTH PORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34287-1473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-423-1777
-----------------------------------------------------
Fax | 941-423-0493
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ERIC JOHN CLAESSENS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 941-423-1777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN11234
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------