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General NPI Number Information
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NPI Number | 1376955443
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Entity Type | Individual
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Provider Name | MICHAEL ALEXANDER DMD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2014
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Last Update Date | 05/23/2014
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Provider Practice Location Address
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Address Line | 800 OAK ST SUITE 101
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City | WINNETKA
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State | IL
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Zip | 60093-2555
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Country | US
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Telephone | 847-446-1560
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Fax |
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Provider Business Mailing Address
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Address Line | 800 OAK ST SUITE 101
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City | WINNETKA
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State | IL
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Zip | 60093-2555
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Country | US
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Telephone |
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 019019543
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN15227
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License Number State | MA
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