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General NPI Number Information
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NPI Number | 1114046075
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Entity Type | Individual
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Provider Name | MICHAEL J COGNATA DMD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 599 BROADWAY
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City | EVERETT
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State | MA
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Zip | 02149-3712
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Country | US
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Telephone | 617-389-1516
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Fax | 617-389-8182
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Provider Business Mailing Address
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Address Line | 599 BROADWAY
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City | EVERETT
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State | MA
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Zip | 02149-3712
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Country | US
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Telephone | 617-389-1516
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Fax | 617-389-8182
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 13926
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License Number State | MA
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