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General NPI Number Information
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NPI Number | 1689960437
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Entity Type | Organization
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Legal Business Name | DEFORTE DENTISTRY
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 4 SWIMMING RIVER RD
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City | LINCROFT
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State | NJ
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Zip | 07738-1727
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Country | US
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Telephone | 732-747-7755
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Fax |
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Provider Business Mailing Address
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Address Line | 4 SWIMMING RIVER RD
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City | LINCROFT
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State | NJ
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Zip | 07738-1727
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Country | US
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Telephone | 732-747-7755
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAROLYN J DEFORTE
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Credential | DMD
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Telephone | 732-747-7755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DI19735
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License Number State | NJ
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