Provider Demographics
NPI:1912644659
Name:ANDUJAR, CLAUDINE
Entity type:Individual
Prefix:
First Name:CLAUDINE
Middle Name:
Last Name:ANDUJAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 CHERRY LAUREL DR APT 203
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-8843
Mailing Address - Country:US
Mailing Address - Phone:786-451-5342
Mailing Address - Fax:
Practice Address - Street 1:4730 W STATE ROAD 46 STE 1220
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9343
Practice Address - Country:US
Practice Address - Phone:407-708-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-15
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist