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General NPI Number Information
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NPI Number | 1275057614
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Entity Type | Organization
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Legal Business Name | MOLAR DENTISTRY PLLC
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Dates
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Enumeration Date | 07/27/2017
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Last Update Date | 06/17/2022
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Provider Practice Location Address
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Address Line | 822 PROSPECT AVE
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City | WESTBURY
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State | NY
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Zip | 11590-3740
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Country | US
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Telephone | 516-717-2690
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Fax | 516-717-2691
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Provider Business Mailing Address
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Address Line | 822 PROSPECT AVE
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City | WESTBURY
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State | NY
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Zip | 11590-3740
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Country | US
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Telephone | 516-717-2690
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Fax | 516-717-2691
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAIFALI RAMETRA
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Credential | DDS
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Telephone | 631-771-1577
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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 | 054475
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License Number State | NY
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