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General NPI Number Information
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NPI Number | 1629809793
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Entity Type | Organization
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Legal Business Name | ELITE ENDODONTICS
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Dates
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Enumeration Date | 08/12/2024
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 1500 HORIZON DR STE 112
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City | CHALFONT
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State | PA
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Zip | 18914-3966
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Country | US
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Telephone | 845-750-5649
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 HORIZON DR STE 112
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City | CHALFONT
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State | PA
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Zip | 18914-3966
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Country | US
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Telephone | 215-997-9888
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Fax | 215-997-9890
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Authorized Official
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Title or Position | CEO
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Name | DR. JACLYN CRUZ
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Credential | DMD
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Telephone | 845-750-5649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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