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General NPI Number Information
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NPI Number | 1780723387
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Entity Type | Individual
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Provider Name | DR. MICHELLE GHUSSON
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 347 5TH AVE SUITE 1310
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City | NEW YORK
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State | NY
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Zip | 10016-5010
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Country | US
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Telephone | 212-279-1232
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Fax | 212-594-8588
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Provider Business Mailing Address
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Address Line | 200 E 15TH ST
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City | NEW YORK
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State | NY
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Zip | 10003-3902
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Country | US
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Telephone |
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 048874-1
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License Number State | NY
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