Provider Demographics
NPI:1366591042
Name:CLAESSENS, ERIC-JOHN (DDS)
Entity type:Individual
Prefix:MR
First Name:ERIC-JOHN
Middle Name:
Last Name:CLAESSENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12450 A SOUTH TAMIAMI TRAIL
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287
Mailing Address - Country:US
Mailing Address - Phone:941-423-1777
Mailing Address - Fax:
Practice Address - Street 1:12450 TAMIAMI TRL S UNIT A
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1473
Practice Address - Country:US
Practice Address - Phone:941-423-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN112341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice