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General NPI Number Information
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NPI Number | 1295275964
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Entity Type | Organization
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Legal Business Name | NORTH PORT ORAL SURGERY AND DENTAL ARTS INC.
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 2787 SYCAMORE ST BUILDING F, SUITE 106
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City | NORTH PORT
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State | FL
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Zip | 34289-9513
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Country | US
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Telephone | 941-223-7228
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 49975
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City | SARASOTA
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State | FL
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Zip | 34230-6975
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Country | US
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Telephone | 941-223-7228
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Fax | 941-423-2005
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. MARK CHRIS BURNE
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Credential | DMD
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Telephone | 941-223-7228
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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 | DN18166
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License Number State | FL
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