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General NPI Number Information
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NPI Number | 1063542421
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Entity Type | Individual
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Provider Name | ELEMER MENDOZA D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8810 S.W. STATE ROAD 200 SUITE 101
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City | OCALA
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State | FL
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Zip | 34481-9636
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Country | US
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Telephone | 352-854-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 2327 BLACK LAKE BLVD.
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City | WINTER GARDEN
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State | FL
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Zip | 34787
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Country | US
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Telephone | 407-921-0340
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Fax | 407-287-7441
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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 | DN17262
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License Number State | FL
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