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General NPI Number Information
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NPI Number | 1407924194
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Entity Type | Individual
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Provider Name | TED B DOMANSKI DDS
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Gender | Male
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1212 US HIGHWAY 1 OLD PORT COVE PLAZA
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City | N PALM BEACH
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State | FL
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Zip | 33408-3536
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Country | US
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Telephone | 561-626-3474
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Fax |
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Provider Business Mailing Address
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Address Line | 19802 LOXAHATCHEE POINTE DR
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City | JUPITER
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State | FL
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Zip | 33458-1814
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Country | US
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Telephone | 561-743-0368
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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 | FL0011250
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License Number State | FL
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