Provider Demographics
NPI:1134379910
Name:STATLER, JENNIFER T (DMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:STATLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 W CAMINO REAL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5513
Mailing Address - Country:US
Mailing Address - Phone:561-368-3688
Mailing Address - Fax:
Practice Address - Street 1:7400 W CAMINO REAL
Practice Address - Street 2:SUITE 110
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5513
Practice Address - Country:US
Practice Address - Phone:561-368-3688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN184321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics