Provider Demographics
NPI:1093940439
Name:KRAMER, EDILENE PORCARO
Entity Type:Individual
Prefix:
First Name:EDILENE
Middle Name:PORCARO
Last Name:KRAMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 NE JENSEN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-7295
Mailing Address - Country:US
Mailing Address - Phone:772-334-6020
Mailing Address - Fax:772-225-5700
Practice Address - Street 1:1852 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-7295
Practice Address - Country:US
Practice Address - Phone:772-334-6020
Practice Address - Fax:772-225-5700
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 157301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice