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General NPI Number Information
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NPI Number | 1477742948
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Entity Type | Individual
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Provider Name | DR. LARA RAGHED EL BASH
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Gender | Female
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 38865 DEQUINDRE RD STE 105
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City | TROY
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State | MI
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Zip | 48083-6812
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Country | US
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Telephone | 248-879-7755
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Fax |
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Provider Business Mailing Address
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Address Line | 12616 E OUTER DR
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City | DETROIT
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State | MI
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Zip | 48224-2764
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Country | US
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Telephone | 313-410-1897
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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 | 2901018771
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License Number State | MI
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