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General NPI Number Information
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NPI Number | 1700142148
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Entity Type | Individual
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Provider Name | MITESH B GANDHI D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 09/07/2015
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Provider Practice Location Address
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Address Line | 364 LOWES DR STE J
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City | DANVILLE
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State | VA
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Zip | 24540-5930
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Country | US
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Telephone | 434-688-0538
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Fax |
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Provider Business Mailing Address
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Address Line | 317 W JERICHO TPKE
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City | HUNTINGTON
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State | NY
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Zip | 11743-6360
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Country | US
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Telephone | 631-252-1520
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Fax | 631-425-7631
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 0401415008
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License Number State | VA
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