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General NPI Number Information
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NPI Number | 1003855156
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Entity Type | Individual
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Provider Name | LOUIS BENJAMIN COLLETTI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 572 ROUTE 6
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City | MAHOPAC
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State | NY
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Zip | 10541-4787
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Country | US
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Telephone | 845-628-8196
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Fax |
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Provider Business Mailing Address
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Address Line | 227 CARPENTER RD
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City | HOPEWELL JUNCTION
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State | NY
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Zip | 12533-6150
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Country | US
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Telephone | 845-227-8095
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 030731
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License Number State | NY
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