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General NPI Number Information
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NPI Number | 1659414126
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Entity Type | Organization
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Legal Business Name | EXCELDENT DENTAL OF ORANGE, LLP
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 380 BOSTON POST RD
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City | ORANGE
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State | CT
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Zip | 06477-3524
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Country | US
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Telephone | 203-795-4748
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Fax | 203-891-8255
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Provider Business Mailing Address
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Address Line | 380 BOSTON POST RD
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City | ORANGE
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State | CT
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Zip | 06477-3524
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Country | US
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Telephone | 203-795-4748
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Fax | 203-891-8255
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. PAUL J KIM
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Credential | D.D.S
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Telephone | 203-795-4748
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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 | 009539
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License Number State | CT
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