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General NPI Number Information
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NPI Number | 1326860099
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Entity Type | Organization
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Legal Business Name | MOUCHAHAM DENTISTRY, LLC
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 10/27/2024
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Provider Practice Location Address
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Address Line | 5790 E MAIN ST STE 110
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City | CARMEL
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State | IN
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Zip | 46033-6200
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Country | US
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Telephone | 317-844-2810
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Fax |
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Provider Business Mailing Address
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Address Line | 14707 KELLER TER
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City | CARMEL
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State | IN
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Zip | 46033-8887
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Country | US
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Telephone | 765-729-2236
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. NICHOLAS MOUCHAHAM
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Credential | DMD
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Telephone | 765-729-2236
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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 |
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License Number State |
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