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General NPI Number Information
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NPI Number | 1598222689
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Entity Type | Organization
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Legal Business Name | AMERICAN CENTER FOR BIOREGULATORY MEDICINE AND DENTISTRY
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 111 CHESTNUT ST STE 1
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City | PROVIDENCE
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State | RI
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Zip | 02903-4169
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Country | US
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Telephone | 833-824-6633
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Fax |
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Provider Business Mailing Address
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Address Line | 111 CHESTNUT ST STE 1
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City | PROVIDENCE
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State | RI
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Zip | 02903-4169
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Country | US
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Telephone | 833-824-6633
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. NICOLE FORTES-WILLIAMS
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Credential | NURSE
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Telephone | 401-270-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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