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General NPI Number Information
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NPI Number | 1164282570
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Entity Type | Organization
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Legal Business Name | HONEST PRACTICES WEST DELRAY PA
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Dates
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Enumeration Date | 03/21/2024
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 8778 W. ATLANTIC AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33446
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Country | US
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Telephone | 561-206-2025
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Fax |
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Provider Business Mailing Address
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Address Line | 8278 BANPO BRIDGE WAY
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City | DELRAY BEACH
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State | FL
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Zip | 33446-0031
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Country | US
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Telephone | 201-406-6596
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Fax |
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | DR. MARK KOGAN
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Credential | DMD, MD
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Telephone | 201-406-6596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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