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General NPI Number Information
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NPI Number | 1457572562
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Entity Type | Individual
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Provider Name | COLIN MICHAEL MCKINNEY D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 800 SE OSCEOLA ST SUITE A
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City | STUART
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State | FL
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Zip | 34994-2447
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Country | US
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Telephone | 772-283-6313
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Fax | 772-287-9515
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Provider Business Mailing Address
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Address Line | 1143 SW WILDRIDGE CT
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City | PALM CITY
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State | FL
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Zip | 34990-2168
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Country | US
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Telephone | 772-692-6996
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Fax | 772-692-7787
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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 | DN15706
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License Number State | FL
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