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General NPI Number Information
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NPI Number | 1801332721
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Entity Type | Organization
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Legal Business Name | ACTIVE CARE ENDODONTICS
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 1745 S KINGS AVE
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City | BRANDON
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State | FL
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Zip | 33511-6220
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Country | US
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Telephone | 813-662-9282
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Fax |
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Provider Business Mailing Address
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Address Line | 1745 S KINGS AVE
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City | BRANDON
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State | FL
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Zip | 33511-6220
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Country | US
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Telephone | 813-662-9282
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. J. MAURICIO GIRALDO
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Credential |
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Telephone | 813-662-9282
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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 | DN0013539
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License Number State | FL
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