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General NPI Number Information
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NPI Number | 1184005241
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Entity Type | Organization
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Legal Business Name | DENTAL FACULTY PRACTICE ASSOC INC - PAUL S. CASAMASSIMO DDS
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 305 W 12TH AVE POSTLE HALL ROOM 4015
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City | COLUMBUS
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State | OH
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Zip | 43210-1267
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Country | US
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Telephone | 614-292-1472
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Fax | 614-688-3553
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Provider Business Mailing Address
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Address Line | 305 W 12TH AVE POSTLE HALL ROOM 4015
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City | COLUMBUS
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State | OH
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Zip | 43210-1267
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Country | US
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Telephone | 614-292-1472
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Fax | 614-688-3553
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Authorized Official
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Title or Position | DIRECTOR
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Name | LINDA M MYERS
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Credential |
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Telephone | 614-292-1472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 71.000244
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License Number State | OH
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