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General NPI Number Information
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NPI Number | 1508416017
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Entity Type | Individual
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Provider Name | MITCHEL GAVINO DDS
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Gender | Male
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 1501 E 10TH ST STE 213
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City | ATLANTIC
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State | IA
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Zip | 50022-1936
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Country | US
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Telephone | 612-968-3576
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 E 10TH ST STE 213
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City | ATLANTIC
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State | IA
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Zip | 50022-1936
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Country | US
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Telephone | 612-968-3576
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS-09710
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D15011
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License Number State | MN
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