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General NPI Number Information
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NPI Number | 1063649580
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Entity Type | Individual
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Provider Name | FALASTIN R. ABU-SAMN DDS
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Gender | Female
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Dates
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Enumeration Date | 06/11/2009
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 2570 S ATLANTIC AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-5523
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Country | US
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Telephone | 386-304-2677
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Fax | 386-304-1899
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Provider Business Mailing Address
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Address Line | 1615 OAK SPRINGS PL
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City | LAKE MARY
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State | FL
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Zip | 32746-4732
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Country | US
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Telephone | 407-417-0847
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN22279
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License Number State | FL
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