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General NPI Number Information
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NPI Number | 1497110662
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Entity Type | Organization
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Legal Business Name | AZ RESTORATION DENTAL PLLC
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 4910 E GREENWAY RD SUITE 7
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-1653
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Country | US
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Telephone | 602-992-2996
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Fax | 602-992-2228
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Provider Business Mailing Address
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Address Line | 4910 E GREENWAY RD SUITE 7
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-1653
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Country | US
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Telephone | 602-992-2996
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Fax | 602-992-2228
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Authorized Official
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Title or Position | PRINCIPAL/OWNER
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Name | MICHAEL B MUSCATO
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Credential | DDS
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Telephone | 602-992-2996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 4730
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License Number State | AZ
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