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General NPI Number Information
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NPI Number | 1538829866
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Entity Type | Organization
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Legal Business Name | DEL RAY ORTHODONTICS LLC
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Dates
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Enumeration Date | 12/28/2021
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 10 SE 1ST AVE STE C
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City | DELRAY BEACH
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State | FL
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Zip | 33444-3693
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Country | US
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Telephone | 561-437-8668
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Fax |
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Provider Business Mailing Address
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Address Line | 10 SE 1ST AVE STE C
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City | DELRAY BEACH
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State | FL
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Zip | 33444-3693
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Country | US
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Telephone | 561-437-8668
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | FAITH GASKINS
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Credential |
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Telephone | 972-869-3789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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