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General NPI Number Information
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NPI Number | 1487852547
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Entity Type | Individual
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Provider Name | MICHAEL CARRAWAY FOREMAN D.M.D., M.S.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 239 SW PROFESSIONAL GLN
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City | LAKE CITY
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State | FL
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Zip | 32025-1105
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Country | US
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Telephone | 386-755-8833
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2589
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City | LAKE CITY
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State | FL
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Zip | 32056-2589
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Country | US
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Telephone | 386-755-8833
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN17084
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License Number State | FL
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