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General NPI Number Information
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NPI Number | 1538577549
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Entity Type | Individual
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Provider Name | DR. JOANA LASTRES
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Gender | Female
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 07/20/2017
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Provider Practice Location Address
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Address Line | 5100 S CLEVELAND AVE # 315316
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City | FORT MYERS
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State | FL
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Zip | 33907-2189
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Country | US
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Telephone | 239-768-2588
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Fax |
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Provider Business Mailing Address
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Address Line | 1890 S.W. HEALTH PARKWAY SUITE 104
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City | NAPLES
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State | FL
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Zip | 34109-2189
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Country | US
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Telephone | 239-594-1171
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN21762
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License Number State | FL
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