MEDICARE: DR. JACK T. KRAUSER 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
1	1223P0300X	Periodontics	DN7727	FL
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN7727	FL

General Provider Information

NPI Number	:	1457574048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK T. KRAUSER DMD

Provider Business Mailing Address
First Line	:	1499 W PALMETTO PARK RD
Second Line	:	STE.302
City	:	BOCA RATON
State	:	FL
Zip	:	33486-3328
Country	:	US
Telephone Number	:	561-392-4747
Fax Number	:	561-392-8320

Provider Business Practice Location Address
First Line	:	1499 W PALMETTO PARK RD
Second Line	:	STE.302
City	:	BOCA RATON
State	:	FL
Zip	:	33486-3328
Country	:	US
Telephone Number	:	561-392-4747
Fax Number	:	561-392-8320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	10/27/2020

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