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General NPI Number Information
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NPI Number | 1154935799
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Entity Type | Organization
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Legal Business Name | ORBIT DENTAL MANAGEMENT PA
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 1453 NW SAINT LUCIE WEST BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1968
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Country | US
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Telephone | 772-348-4403
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Fax | 772-348-4342
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Provider Business Mailing Address
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Address Line | 1453 NW SAINT LUCIE WEST BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1968
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Country | US
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Telephone | 772-348-4403
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Fax | 772-348-4342
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Authorized Official
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Title or Position | OWNER
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Name | MIKHAIL GANKIN
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Credential |
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Telephone | 772-348-4403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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