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General NPI Number Information
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NPI Number | 1497858864
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Entity Type | Organization
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Legal Business Name | RISSER ENDODONTICS P.C.
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 225 N NOTRE DAME AVE SUITE 2
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City | SOUTH BEND
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State | IN
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Zip | 46617
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Country | US
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Telephone | 574-232-5866
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Fax | 574-287-8891
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Provider Business Mailing Address
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Address Line | 225 N NOTRE DAME AVE SUITE 2
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City | SOUTH BEND
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State | IN
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Zip | 46617
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Country | US
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Telephone | 574-232-5866
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Fax | 574-287-8891
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT ELLIOT RISSER
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Credential | DDS MSD
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Telephone | 574-232-5866
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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 | 12010063A
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License Number State | IN
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