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General NPI Number Information
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NPI Number | 1801574819
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Entity Type | Organization
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Legal Business Name | CENTRE ENDODONTICS, LLC
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 486 WASHINGTON ST LOWR LEVEL
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City | WELLESLEY
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State | MA
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Zip | 02482-5971
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Country | US
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Telephone | 617-410-8595
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Fax |
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Provider Business Mailing Address
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Address Line | 486 WASHINGTON ST LOWR LEVEL
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City | WELLESLEY
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State | MA
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Zip | 02482-5971
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Country | US
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Telephone | 617-410-8595
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Fax |
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Authorized Official
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Title or Position | ENDODONTIST/OWNER
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Name | DR. MIGUEL A ROQUE
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Credential | DMD, MMSC
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Telephone | 617-410-8595
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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 |
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License Number State |
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