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General NPI Number Information
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NPI Number | 1669960027
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Entity Type | Organization
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Legal Business Name | NEW ENGLAND FAMILY DENTISTRY ,PC
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 05/01/2018
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Provider Practice Location Address
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Address Line | 366 COOLEY ST
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City | SPRINGFIELD
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State | MA
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Zip | 01128-1144
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Country | US
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Telephone | 413-796-1616
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Fax | 413-796-1617
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Provider Business Mailing Address
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Address Line | 5 MOUNT ROYAL AVE STE 300
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City | MARLBOROUGH
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State | MA
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Zip | 01752-1900
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Country | US
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Telephone | 508-460-0632
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | LISA J CHOINIERE
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Credential |
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Telephone | 508-460-0632
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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 | 1857191
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License Number State | MA
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