MEDICARE: DR. JENNIFER ADELSON DDS

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	1223P0221X	Pediatric Dentistry	DN 15540	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	203110655	OTHER	FL	TAX PAYER IDENTIFICATION

General Provider Information

NPI Number	:	1588868962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER ADELSON DDS

Provider Business Mailing Address
First Line	:	501 GOLDEN ISLES DR
Second Line	:	SUITE # 202
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4729
Country	:	US
Telephone Number	:	954-889-8889
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 GOLDEN ISLES DR
Second Line	:	SUITE # 202
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4729
Country	:	US
Telephone Number	:	954-889-8889
Fax Number	:

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

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	12/19/2012

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