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General NPI Number Information
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NPI Number | 1346369980
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Entity Type | Individual
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Provider Name | LEANNE BARBARA SULLIVAN DMD
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5713 GRAY RD
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City | WESLEY CHAPEL
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State | FL
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Zip | 33543-4514
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Country | US
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Telephone | 813-991-0097
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Fax | 813-973-1738
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Provider Business Mailing Address
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Address Line | 1904 REBECCA RD
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City | LUTZ
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State | FL
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Zip | 33548-4540
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Country | US
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Telephone | 813-991-0097
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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 | DN17166
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License Number State | FL
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