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General NPI Number Information
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NPI Number | 1598874752
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Entity Type | Individual
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Provider Name | OLIVER PETER FAVALLI
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 5150 MASON CORBIN CT SUITE #2
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City | FORT MYERS
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State | FL
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Zip | 33907
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Country | US
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Telephone | 239-418-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 7117 CONGDON ROAD SUITE 100
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City | FORT MYERS
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State | FL
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Zip | 33908
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Country | US
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Telephone | 239-418-1444
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Fax | 239-418-1888
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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 | 13738
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 13738
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License Number State | FL
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