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General NPI Number Information
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NPI Number | 1790787810
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH MACCARO D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 04/15/2023
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Provider Practice Location Address
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Address Line | 10 N ALAMOS DR
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4020
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Country | US
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Telephone | 928-634-6641
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Fax |
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Provider Business Mailing Address
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Address Line | 944 E STERLING LN
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City | FLAGSTAFF
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State | AZ
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Zip | 86005-6571
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Country | US
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Telephone | 928-310-7130
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 16775
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D010318
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License Number State | AZ
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