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General NPI Number Information
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NPI Number | 1366511172
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Entity Type | Individual
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Provider Name | DEBORA G. DE FARIAS D.D.S, MS
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Gender | Female
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7740 POINT MEADOWS DR SUITE 4
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9179
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Country | US
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Telephone | 904-645-6457
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Fax | 904-645-6459
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Provider Business Mailing Address
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Address Line | 11475 HALETHORPE DR
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City | JACKSONVILLE
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State | FL
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Zip | 32223-1313
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Country | US
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Telephone | 904-288-9503
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17099
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License Number State | FL
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