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General NPI Number Information
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NPI Number | 1003277054
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE DENTAL CARE P C
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 127 W MAIN ST
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City | EAST ISLIP
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State | NY
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Zip | 11730
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Country | US
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Telephone | 631-379-3902
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Fax |
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Provider Business Mailing Address
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Address Line | 325 LAKE AVE UNIT 748
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City | SAINT JAMES
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State | NY
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Zip | 11780-5045
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT SIMONETTI
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Credential | DDS
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Telephone | 631-379-3902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 049510
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License Number State | NY
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