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General NPI Number Information
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NPI Number | 1063023430
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Entity Type | Organization
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Legal Business Name | WESTSIDE DENTAL SLEEP CENTER LLC
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 18611 DETROIT AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-3205
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Country | US
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Telephone | 216-221-2210
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Fax |
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Provider Business Mailing Address
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Address Line | 30701 LORAIN RD STE A
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-6325
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Country | US
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Telephone | 440-274-5000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL S PAP
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Credential | DDS
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Telephone | 216-221-2210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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