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General NPI Number Information
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NPI Number | 1568632990
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Entity Type | Individual
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Provider Name | ROY C BLAKE III DDS MSD
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Gender | Male
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 200 BUTLER ST SUITE 203
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-6036
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Country | US
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Telephone | 561-296-3399
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Fax | 561-202-6776
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Provider Business Mailing Address
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Address Line | 200 BUTLER ST SUITE 203
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-6036
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Country | US
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Telephone | 561-296-3399
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Fax | 561-202-6776
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN9551
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License Number State | FL
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