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General NPI Number Information
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NPI Number | 1447715453
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Entity Type | Individual
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Provider Name | ROMAN MICHAEL GARCIA DMD, MPH
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Gender | Male
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 1600 GARTH BROOKS BLVD
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City | YUKON
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State | OK
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Zip | 73099-6469
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Country | US
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Telephone | 405-578-5234
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Fax |
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Provider Business Mailing Address
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Address Line | 4208 RIVA RIDGE CT
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City | EDMOND
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State | OK
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Zip | 73025-0831
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Country | US
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Telephone | 561-309-0269
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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 | 7934
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 152
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License Number State | OK
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