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General NPI Number Information
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NPI Number | 1073923017
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Entity Type | Individual
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Provider Name | AVRAHAM AMSALEM D.D.S, M.D
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Gender | Male
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 21200 SAINT ANDREWS BLVD STE 15
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City | BOCA RATON
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State | FL
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Zip | 33433-2403
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Country | US
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Telephone | 561-571-7108
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Fax |
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Provider Business Mailing Address
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Address Line | 7881 SAN MARCOS PL
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City | BOCA RATON
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State | FL
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Zip | 33433-4125
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Country | US
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Telephone | 561-685-0909
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN21695
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License Number State | FL
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