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General NPI Number Information
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NPI Number | 1700121977
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Entity Type | Organization
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Legal Business Name | DENTISTRY BY DESIGN, LLC
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 672 SW PRIMA VISTA BLVD 202
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-1820
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Country | US
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Telephone | 772-905-2741
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Fax | 772-336-8266
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | JUPITER
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State | FL
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Zip | 33468-0069
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Country | US
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Telephone | 561-932-0995
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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. MAZIN SHIKARA
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Credential | M.D.
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Telephone | 561-932-0995
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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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