Provider Demographics
NPI:1699115816
Name:SHRAITEH, JENAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JENAN
Middle Name:
Last Name:SHRAITEH
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 1:19336 PRESERVE DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4816
Mailing Address - Country:US
Mailing Address - Phone:561-379-5087
Mailing Address - Fax:
Practice Address - Street 1:528 MIRACLE MILE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5450
Practice Address - Country:US
Practice Address - Phone:772-978-9383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN202521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice