Provider Demographics
NPI:1578193983
Name:JACK T KRAUSER DMD PLLC
Entity Type:Organization
Organization Name:JACK T KRAUSER DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:T
Authorized Official - Last Name:KRASUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-627-5560
Mailing Address - Street 1:824 US HIGHWAY 1 STE 370
Mailing Address - Street 2:
Mailing Address - City:N PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:824 US HIGHWAY 1 STE 370
Practice Address - Street 2:
Practice Address - City:N PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3861
Practice Address - Country:US
Practice Address - Phone:561-627-5560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental