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General NPI Number Information
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NPI Number | 1043714868
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Entity Type | Organization
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Legal Business Name | FAMILY DENTISTRY OF KEYPORT LLC
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 45 MAPLE PL
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City | KEYPORT
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State | NJ
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Zip | 07735-1358
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Country | US
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Telephone | 732-246-9411
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Fax |
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Provider Business Mailing Address
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Address Line | 90 BROOKLAWN AVE
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City | BRIDGEPORT
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State | CT
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Zip | 06604-2010
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Country | US
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Telephone | 203-334-4837
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Fax | 203-366-9195
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Authorized Official
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Title or Position | MANAGER
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Name | JANIE PADILLA
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Credential |
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Telephone | 732-246-9411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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