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General NPI Number Information
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NPI Number | 1730496548
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Entity Type | Organization
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Legal Business Name | CLINICA DENTAL RAFAEL J.GOMEZ MATTA PSC
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 57 CALLE DEGETAU N
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City | AIBONITO
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State | PR
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Zip | 00705-3613
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Country | US
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Telephone | 787-735-3500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2124
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City | AIBONITO
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State | PR
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Zip | 00705-2124
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Country | US
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Telephone | 787-735-3500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAFAEL JOSE GOMEZ
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Credential | DMD
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Telephone | 787-735-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0721
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License Number State | PR
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