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General NPI Number Information
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NPI Number | 1174887061
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Entity Type | Individual
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Provider Name | MICHAEL DAVID FOW D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 5533 E BELL RD STE 117
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-1256
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Country | US
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Telephone | 602-867-2712
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Fax | 602-867-1082
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Provider Business Mailing Address
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Address Line | 5533 E BELL RD STE 117
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-1256
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Country | US
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Telephone | 602-867-2712
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Fax | 602-867-1082
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D008468
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License Number State | AZ
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