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General NPI Number Information
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NPI Number | 1518439967
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Entity Type | Organization
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Legal Business Name | MEDIDENTAL GROUP LLC
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Dates
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Enumeration Date | 12/26/2018
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 2246 31ST ST
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City | ASTORIA
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State | NY
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Zip | 11105-2786
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Country | US
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Telephone | 347-283-2396
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Fax |
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Provider Business Mailing Address
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Address Line | 2246 31ST ST
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City | ASTORIA
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State | NY
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Zip | 11105-2786
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Country | US
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Telephone | 347-283-2396
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. EMANUEL INOYATOV
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Credential |
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Telephone | 347-283-2396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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