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General NPI Number Information
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NPI Number | 1164719456
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Entity Type | Organization
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Legal Business Name | ORAL CARE DENTAL GROUP II, LLC
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Dates
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Enumeration Date | 07/07/2011
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 330 MAIN ST
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City | HARTFORD
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State | CT
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Zip | 06106-1860
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Country | US
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Telephone | 860-444-9345
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Fax |
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Provider Business Mailing Address
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Address Line | 330 MAIN ST
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City | HARTFORD
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State | CT
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Zip | 06106-1860
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Country | US
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Telephone | 860-444-9345
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Fax | 860-443-0432
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Authorized Official
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Title or Position | BUSINESS/FINANCE MANAGER
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Name | MS. ANGELINA SANTA MARIA
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Credential |
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Telephone | 860-444-9345
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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 | 8727
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License Number State | CT
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