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General NPI Number Information
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NPI Number | 1275225526
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Entity Type | Individual
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Provider Name | RAJEEV SHAH PATEL D.M.D
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Gender | Male
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 790 SKYMARKS DR STE 109
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City | JACKSONVILLE
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State | FL
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Zip | 32218-7267
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Country | US
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Telephone | 904-982-7317
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Fax |
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Provider Business Mailing Address
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Address Line | 7749 ROYAL CREST DR # 32256
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City | JACKSONVILLE
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State | FL
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Zip | 32256-2345
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Country | US
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Telephone | 904-982-7317
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN27915
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License Number State | FL
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