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General NPI Number Information
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NPI Number | 1154481075
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Entity Type | Individual
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Provider Name | WILLIAM A MOON DDS
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Gender | Male
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 1700 BAKER AVE EAST
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City | HAINES CITY
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State | FL
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Zip | 33844-4325
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Country | US
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Telephone | 863-419-3252
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Fax | 863-419-3497
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Provider Business Mailing Address
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Address Line | 1290 GOLFVIEW AVE ATTN: ACCOUNTS RECEIVABLE
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City | BARTOW
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State | FL
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Zip | 33830-6740
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Country | US
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Telephone | 863-519-7900
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Fax | 863-519-7696
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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 | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | DN7469
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License Number State | FL
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