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General NPI Number Information
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NPI Number | 1376799510
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Entity Type | Organization
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Legal Business Name | AUSTIN DENTAL CARE
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Dates
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Enumeration Date | 08/07/2008
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 7017 AUSTIN ST #3D
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City | FOREST HILLS
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State | NY
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Zip | 11375-4722
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Country | US
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Telephone | 718-544-4440
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Fax | 718-233-2723
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Provider Business Mailing Address
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Address Line | 7017 AUSTIN ST #3D
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City | FOREST HILLS
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State | NY
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Zip | 11375-4722
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Country | US
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Telephone | 718-544-4440
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Fax | 718-233-2723
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Authorized Official
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Title or Position | DENTIST
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Name | DR. FARANAK BALAZADEH
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Credential | DDS
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Telephone | 718-544-4440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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