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General NPI Number Information
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NPI Number | 1255410742
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Entity Type | Organization
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Legal Business Name | SUMMIT DENTAL CENTER, PA
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 3913 N ANDREWS AVE
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City | OAKLAND PARK
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State | FL
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Zip | 33309-5239
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Country | US
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Telephone | 954-561-6675
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Fax | 954-630-2017
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Provider Business Mailing Address
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Address Line | 3913 N ANDREWS AVE
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City | OAKLAND PARK
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State | FL
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Zip | 33309-5239
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Country | US
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Telephone | 954-561-6675
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Fax | 954-630-2017
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Authorized Official
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Title or Position | DIRECTOR
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Name | JEAN R ELYSEE
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Credential | DDS
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Telephone | 954-561-6675
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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 | DN0014412
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License Number State | FL
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