Provider Demographics
NPI:1740498252
Name:KAUFMAN, JEANIE F (DDS)
Entity type:Individual
Prefix:DR
First Name:JEANIE
Middle Name:F
Last Name:KAUFMAN
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 1:1077 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-3459
Mailing Address - Country:US
Mailing Address - Phone:530-541-1353
Mailing Address - Fax:530-541-3229
Practice Address - Street 1:1077 4TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-3459
Practice Address - Country:US
Practice Address - Phone:530-541-1353
Practice Address - Fax:530-541-3229
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28339122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist