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General NPI Number Information
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NPI Number | 1295150845
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Entity Type | Organization
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Legal Business Name | FLORIDA CENTER FOR ORAL SURGERY & DENTAL IMPLANTS
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 12651 W SUNRISE BLVD SUITE 304
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City | SUNRISE
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State | FL
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Zip | 33323-0906
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Country | US
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Telephone | 954-845-0098
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Fax | 954-845-0280
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Provider Business Mailing Address
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Address Line | 12651 W SUNRISE BLVD SUITE 304
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City | SUNRISE
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State | FL
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Zip | 33323-0906
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Country | US
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Telephone | 954-845-0098
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Fax | 954-845-0280
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAMONE E SMITH
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Credential | D.D.S.
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Telephone | 954-845-0098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN16488
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License Number State | FL
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