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General NPI Number Information
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NPI Number | 1205961166
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Entity Type | Organization
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Legal Business Name | ALL FAMILY DENTAL CARE, LLC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 417 W CENTRAL AVE
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City | COOLIDGE
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State | AZ
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Zip | 85228-4708
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Country | US
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Telephone | 520-723-1111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1546
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City | COOLIDGE
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State | AZ
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Zip | 85228-1546
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Country | US
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Telephone | 520-723-1111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAX A ALMODOVAR
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Credential | DMD
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Telephone | 602-391-6649
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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 | 6633
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License Number State | AZ
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