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General NPI Number Information
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NPI Number | 1073110177
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Entity Type | Organization
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Legal Business Name | CORAL SPRINGS DENTAL GROUP, LLC
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 2029 N UNIVERSITY DR
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-6132
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Country | US
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Telephone | 954-787-1000
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Fax | 561-413-2468
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Provider Business Mailing Address
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Address Line | 4765 W ATLANTIC AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33445-3838
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Country | US
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Telephone | 954-718-3384
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Fax | 561-431-2468
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Authorized Official
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Title or Position | MANAGER
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Name | INGRID J ROMERO
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Credential | DMD
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Telephone | 561-485-1000
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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 |
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License Number State |
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