Provider Demographics
NPI:1821401001
Name:JENNIFER M. ADELSON, DDS, PA
Entity Type:Organization
Organization Name:JENNIFER M. ADELSON, DDS, PA
Other - Org Name:TIKI DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-889-8889
Mailing Address - Street 1:501 GOLDEN ISLES DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4729
Mailing Address - Country:US
Mailing Address - Phone:954-889-8889
Mailing Address - Fax:954-862-6899
Practice Address - Street 1:501 GOLDEN ISLES DR
Practice Address - Street 2:SUITE 202
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4729
Practice Address - Country:US
Practice Address - Phone:954-889-8889
Practice Address - Fax:954-862-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15540261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental