Provider Demographics
NPI:1396429452
Name:CLAUSSEN, JENNIFER (DMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CLAUSSEN
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 1:13512 LODI TER APT 5209
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7449
Mailing Address - Country:US
Mailing Address - Phone:786-712-5244
Mailing Address - Fax:
Practice Address - Street 1:1993 DANIELS RD STE 120
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4598
Practice Address - Country:US
Practice Address - Phone:407-863-0476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02978100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist