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General NPI Number Information
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NPI Number | 1063871804
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Entity Type | Individual
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Provider Name | ROSS ANDREW HAUER DMD
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Gender | Male
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 1722 SW SAINT LUCIE WEST BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-2504
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Country | US
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Telephone | 772-337-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E CAMINO REAL APT 1041
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City | BOCA RATON
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State | FL
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Zip | 33432-6181
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Country | US
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Telephone | 954-695-5489
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN21896
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN21896
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License Number State | FL
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