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General NPI Number Information
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NPI Number | 1801945530
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Entity Type | Individual
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Provider Name | TRYPHOSE CHARLES DMD
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 04/27/2018
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Provider Practice Location Address
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Address Line | 3030 N 67TH PL UNIT 126
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6082
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Country | US
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Telephone | 480-359-3525
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Fax |
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Provider Business Mailing Address
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Address Line | 15509 N SCOTTSDALE RD UNIT 1047
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-3107
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Country | US
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Telephone | 203-550-0996
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 008039
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 009908
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License Number State | AZ
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