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General NPI Number Information
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NPI Number | 1114953494
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Entity Type | Individual
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Provider Name | LIA DOMINICI-BLY D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 10/11/2013
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Provider Practice Location Address
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Address Line | 6700 KALANIANAOLE HWY SUITE 107
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City | HONOLULU
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State | HI
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Zip | 96825-1277
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Country | US
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Telephone | 808-396-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 2732 E MANOA RD #A
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City | HONOLULU
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State | HI
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Zip | 96822-1818
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Country | US
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Telephone | 808-729-6107
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DT1722
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License Number State | HI
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