Provider Demographics
NPI:1861543688
Name:CARUSO, JENNIFER T (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:T
Last Name:CARUSO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:G
Other - Last Name:TSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:11279 CAMINO RUIZ
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4601
Mailing Address - Country:US
Mailing Address - Phone:858-566-5650
Mailing Address - Fax:
Practice Address - Street 1:11279 CAMINO RUIZ
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4601
Practice Address - Country:US
Practice Address - Phone:858-566-5650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60906122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist