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General NPI Number Information
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NPI Number | 1144531393
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Entity Type | Organization
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Legal Business Name | PHOENIX ENDODONTIC CENTER LLC
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 13821 N 35TH DR STE 2
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City | PHOENIX
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State | AZ
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Zip | 85053-5541
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Country | US
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Telephone | 602-375-8063
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Fax | 602-863-3412
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Provider Business Mailing Address
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Address Line | 13821 N. 35TH DRIVE SUITE 2
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City | PHOENIX
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State | AZ
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Zip | 85053
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Country | US
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Telephone | 602-375-8063
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Fax | 602-863-3412
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY JOSEPH CORE
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Credential | D.D.S
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Telephone | 602-375-8063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2928
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License Number State | AZ
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