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NPI 1639496094

NPI 1639496094 : NATALIA ELSON DDS : ISLIP, NY

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General NPI Number Information
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    NPI Number           |    1639496094
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    Entity Type          |    Individual 
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    Provider Name        |    NATALIA ELSON DDS
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    04/26/2010
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    Last Update Date     |    07/01/2013
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Provider Practice Location Address
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    Address Line         |    150 ISLIP AVE STE 5 NATALIA ELSON DDS PC
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    City                 |    ISLIP
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    State                |    NY
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    Zip                  |    11751-3222
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    Country              |    US
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    Telephone            |    631-581-0216
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    Fax                  |    631-581-2415
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Provider Business Mailing Address
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    Address Line         |    150 ISLIP AVE STE 5 NATALIA ELSON DDS PC
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    City                 |    ISLIP
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    State                |    NY
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    Zip                  |    11751-3222
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    Country              |    US
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    Telephone            |    631-581-0216
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    Fax                  |    631-581-2415
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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        |    122300000X
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    Taxonomy Name        |    Dentist
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    License Number       |    055703
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    License Number State |    NY
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