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General NPI Number Information
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NPI Number | 1508195975
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Entity Type | Organization
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Legal Business Name | RODNEY RASTEGAR DDS PLLC
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 01/13/2016
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Provider Practice Location Address
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Address Line | 601 FRANKLIN AVE SUITE 110
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City | GARDEN CITY
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State | NY
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Zip | 11530
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Country | US
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Telephone | 516-741-4415
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Fax | 516-741-4417
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Provider Business Mailing Address
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Address Line | 23 BOND STREET
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City | GREAT NECK
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State | NY
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Zip | 11021
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Country | US
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Telephone | 516-482-0329
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Fax | 516-482-0401
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JENNIFER L DAVILA
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Credential |
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Telephone | 516-741-4415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 048692
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License Number State | NY
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