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General NPI Number Information
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NPI Number | 1790087138
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Entity Type | Organization
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Legal Business Name | ERIC R. CLAUSSEN, D.M.D., P.A.
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 2624 JENKS AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4311
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Country | US
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Telephone | 850-215-0798
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Fax |
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Provider Business Mailing Address
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Address Line | 2624 JENKS AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4311
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Country | US
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Telephone | 850-215-0798
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC RICHARD CLAUSSEN
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Credential | D.M.D.
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Telephone | 407-408-4880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D17080
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License Number State | FL
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