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General NPI Number Information
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NPI Number | 1013457696
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Entity Type | Individual
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Provider Name | SI SHI DDS
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Gender | Female
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 751 OAK ST STE 601
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City | JACKSONVILLE
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State | FL
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Zip | 32204-3373
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Country | US
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Telephone | 904-354-4031
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Fax |
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Provider Business Mailing Address
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Address Line | 4929 SKYWAY DR APT 3312
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City | JACKSONVILLE
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State | FL
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Zip | 32246-0040
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Country | US
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Telephone | 917-502-8308
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN25511
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License Number State | FL
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