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General NPI Number Information
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NPI Number | 1508152067
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Entity Type | Individual
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Provider Name | ALLISON KONICK DMD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 11155 STATE ROAD 70 EAST
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202
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Country | US
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Telephone | 941-953-5565
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Fax | 813-336-0836
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Provider Business Mailing Address
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Address Line | 11155 STATE ROAD 70 EAST
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-1307
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Country | US
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Telephone | 941-953-5565
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Fax | 813-336-0836
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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 | 19386
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License Number State | FL
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