Provider Demographics
NPI:1457574048
Name:KRAUSER, JACK T (DMD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:T
Last Name:KRAUSER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 W PALMETTO PARK RD
Mailing Address - Street 2:STE.302
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3328
Mailing Address - Country:US
Mailing Address - Phone:561-392-4747
Mailing Address - Fax:561-392-8320
Practice Address - Street 1:1499 W PALMETTO PARK RD
Practice Address - Street 2:STE.302
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3328
Practice Address - Country:US
Practice Address - Phone:561-392-4747
Practice Address - Fax:561-392-8320
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN77271223P0300X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0300XDental ProvidersDentistPeriodontics