Individual
JENNIFER T. VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2050 OLD HICKORY TREE RD, SUITE I, SAINT CLOUD, FL 34772-8926
(407) 556-3969
Mailing address
2704 CYPRESSWAY CT, ORLANDO, FL 32825-8563
(954) 483-8184
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN18003
FL
Other
Enumeration date
06/28/2007
Last updated
04/16/2010
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