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General NPI Number Information
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NPI Number | 1629329198
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Entity Type | Organization
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Legal Business Name | AMHERST ORAL SURGERY AND IMPLANT CENTER LLC
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 550 N LEAVITT RD
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City | AMHERST
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State | OH
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Zip | 44001-1131
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Country | US
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Telephone | 440-988-3400
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Fax | 440-988-3405
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Provider Business Mailing Address
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Address Line | 550 N LEAVITT RD
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City | AMHERST
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State | OH
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Zip | 44001-1131
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Country | US
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Telephone | 440-988-3400
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Fax | 440-988-3405
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY W KOSMAN
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Credential | D.D.S.
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Telephone | 440-988-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 35099912
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License Number State | OH
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