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General NPI Number Information
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NPI Number | 1063781086
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Entity Type | Organization
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Legal Business Name | HARBOR VIEW ORAL AND FACIAL SURGERY LLC
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 1301 25TH AVENUE SUITE 3
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City | GULFPORT
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State | MS
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Zip | 39501
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Country | US
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Telephone | 228-867-0121
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Fax | 228-867-0252
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Provider Business Mailing Address
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Address Line | 1301 25TH AVENUE SUITE 3
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City | GULFPORT
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State | MS
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Zip | 39501
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Country | US
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Telephone | 228-867-0121
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Fax | 228-867-0252
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. JASON O ROSETTI
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Credential | DDS
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Telephone | 228-867-0121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 335805
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License Number State | MS
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