Provider Demographics
NPI:1588868962
Name:ADELSON, JENNIFER (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:ADELSON
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 1:501 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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 155401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL203110655OtherTAX PAYER IDENTIFICATION