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General NPI Number Information
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NPI Number | 1669671269
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Entity Type | Organization
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Legal Business Name | LASER DENTAL CENTERS,CSP
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | ASHFORD MEDICAL CENTER SUITE 808 # 29
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City | SAN JUAN
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State | PR
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Zip | 00907
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Country | US
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Telephone | 787-728-4776
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Fax | 787-725-4776
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Provider Business Mailing Address
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Address Line | PMB 352 # 35 JUAN C BORBON STE 67
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City | GUAYNABO
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State | PR
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Zip | 00969
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Country | US
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Telephone | 787-725-4776
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Fax | 787-725-4776
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Authorized Official
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Title or Position | DENTITA
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Name | DR. CLYDE FASICK JULIA
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Credential | MD
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Telephone | 787-725-4776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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