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General NPI Number Information
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NPI Number | 1174945778
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Entity Type | Organization
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Legal Business Name | KAMILIA DENTAL LLC
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 01/16/2014
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Provider Practice Location Address
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Address Line | 838 HIGH RIDGE RD
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City | STAMFORD
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State | CT
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Zip | 06905-1913
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Country | US
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Telephone | 203-322-5153
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Fax |
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Provider Business Mailing Address
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Address Line | 1 HARBORSIDE PL #744
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City | JERSEY CITY
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State | NJ
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Zip | 07311-3908
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Country | US
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Telephone | 860-205-3390
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | KAMILIA KEMAL SAID
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Credential | DMD
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Telephone | 860-205-3390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 010475
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License Number State | CT
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