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General NPI Number Information
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NPI Number | 1710298799
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Entity Type | Individual
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Provider Name | NICHOLAS PARKER COMERFORD DMD
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Gender | Male
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Dates
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Enumeration Date | 06/24/2010
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 4521 ATLANTIC BLVD SUITE B
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City | JACKSONVILLE
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State | FL
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Zip | 32207-1137
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Country | US
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Telephone | 904-374-3787
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Fax | 904-629-6571
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Provider Business Mailing Address
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Address Line | 4521 ATLANTIC BLVD SUITE B
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City | JACKSONVILLE
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State | FL
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Zip | 32207-1137
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Country | US
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Telephone | 904-374-3787
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Fax | 904-619-6571
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN19070
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License Number State | FL
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