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General NPI Number Information
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NPI Number | 1720163884
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Entity Type | Individual
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Provider Name | TODD MITCHELL RETELL DDS
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 39 ELIZABETH DR
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City | LOCKPORT
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State | NY
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Zip | 14094-5226
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Country | US
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Telephone | 716-433-6004
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Fax |
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Provider Business Mailing Address
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Address Line | 4514 SHARON DR
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City | LOCKPORT
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State | NY
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Zip | 14094-1314
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Country | US
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Telephone | 716-439-8565
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Fax |
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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 | 41617
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License Number State | NY
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