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General NPI Number Information
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NPI Number | 1609416999
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Entity Type | Organization
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Legal Business Name | MOBILE DENTAL CARE ASSOCIATE LLC
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 01/14/2020
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Provider Practice Location Address
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Address Line | 55 SARGENT DRIVE
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City | BETHANY
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State | CT
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Zip | 06524-3135
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Country | US
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Telephone | 475-238-8165
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Fax | 475-655-2967
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Provider Business Mailing Address
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Address Line | 55 SARGENT DRIVE
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City | BETHANY
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State | CT
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Zip | 06524-3135
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Country | US
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Telephone | 475-238-8165
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Fax | 475-655-2967
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MR. MICHAEL YOUNG
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Credential | DDS
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Telephone | 475-238-8165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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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 | 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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