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General NPI Number Information
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NPI Number | 1295921286
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Entity Type | Organization
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Legal Business Name | DENTAL FACIAL IMAGING LLC
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 1705 RENAISSANCE BLVD SUITE 135
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City | EDMOND
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State | OK
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Zip | 73013-3041
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Country | US
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Telephone | 405-285-9697
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Fax | 405-285-6902
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Provider Business Mailing Address
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Address Line | 1705 RENAISSANCE BLVD SUITE 135
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City | EDMOND
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State | OK
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Zip | 73013-3041
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Country | US
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Telephone | 405-285-9697
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Fax | 405-285-6902
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. CHARLES SCHIAVO
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Credential |
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Telephone | 405-285-9697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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