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General NPI Number Information
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NPI Number | 1760527592
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Entity Type | Organization
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Legal Business Name | AFFILIATED FAMILY DENTISTS PC
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 01/24/2011
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Provider Practice Location Address
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Address Line | 605 W DOUGLAS ROAD
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City | MISHAWAKA
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State | IN
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Zip | 46545
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Country | US
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Telephone | 574-277-2220
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Fax | 574-277-8108
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Provider Business Mailing Address
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Address Line | 605 W DOUGLAS ROAD
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City | MISHAWAKA
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State | IN
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Zip | 46545
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Country | US
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Telephone | 574-277-2220
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Fax | 574-277-8108
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Authorized Official
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Title or Position | TREATMENT COORDINATOR
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Name | MS. CHARYL KRIVAK
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Credential |
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Telephone | 574-277-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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