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General NPI Number Information
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NPI Number | 1730487976
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Entity Type | Individual
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Provider Name | MR. JOSEPH ROSS GUZZARDI
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Gender | Male
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Dates
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Enumeration Date | 03/12/2011
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Last Update Date | 11/26/2013
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Provider Practice Location Address
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Address Line | 733 TERRYVILLE AVE
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City | BRISTOL
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State | CT
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Zip | 06010-4034
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Country | US
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Telephone | 860-584-0441
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Fax |
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Provider Business Mailing Address
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Address Line | 25 QUARRY KNOLL CIR
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City | MANCHESTER
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State | CT
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Zip | 06040-7142
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Country | US
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Telephone | 860-895-7784
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 010905
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License Number State | CT
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