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General NPI Number Information
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NPI Number | 1003313594
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Entity Type | Individual
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Provider Name | CODY HAYES MUMMA DDS
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Gender | Male
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 4716 W URBANA ST
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City | BROKEN ARROW
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State | OK
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Zip | 74012-6162
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Country | US
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Telephone | 918-449-5800
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Fax | 918-455-8958
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Provider Business Mailing Address
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Address Line | 2201 HEMPSTEAD TPKE
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City | EAST MEADOW
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State | NY
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Zip | 11554-1859
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Country | US
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Telephone | 516-572-8774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 229
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License Number State | OK
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