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General NPI Number Information
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NPI Number | 1174818678
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Entity Type | Individual
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Provider Name | SAMANTHA J LYNCH
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Gender | Female
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 525 W END AVE SUITE 1G
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City | NEW YORK
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State | NY
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Zip | 10024-3267
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Country | US
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Telephone | 212-874-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 1 WILDWOOD GDNS APT A2
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-2308
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Country | US
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Telephone | 516-617-8787
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 056476
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License Number State | NY
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