Provider Demographics
NPI:1497049597
Name:BEURSKENS, JENNIFER MICHELE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MICHELE
Last Name:BEURSKENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-0648
Mailing Address - Country:US
Mailing Address - Phone:620-331-4859
Mailing Address - Fax:620-331-4863
Practice Address - Street 1:117 N PENN AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3523
Practice Address - Country:US
Practice Address - Phone:620-331-4859
Practice Address - Fax:620-331-4863
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS606851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice