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General NPI Number Information
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NPI Number | 1043410491
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Entity Type | Individual
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Provider Name | MITCHELL R EDLUND DDS MS PA
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Gender | Male
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 2910 BEE RIDGE ROAD
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City | SARASOTA
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State | FL
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Zip | 34239
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Country | US
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Telephone | 941-371-8448
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Fax | 941-924-4234
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Provider Business Mailing Address
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Address Line | 2910 BEE RIDGE ROAD
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City | SARASOTA
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State | FL
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Zip | 34239
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Country | US
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Telephone | 941-371-8448
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Fax | 941-924-4234
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DRP 547
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License Number State | FL
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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 | DN20067
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License Number State | FL
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