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General NPI Number Information
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NPI Number | 1811258627
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Entity Type | Organization
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Legal Business Name | MIKE E. CALDERON DDS PC
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 720 MONTAUK HWY
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City | WEST ISLIP
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State | NY
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Zip | 11795-4411
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Country | US
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Telephone | 631-666-1392
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 SUNRISE HWY.
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City | BAY SHORE
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State | NY
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Zip | 11706
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Country | US
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Telephone | 631-666-1392
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Fax | 631-666-1520
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Authorized Official
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Title or Position | DENTIST
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Name | MIKE ELVIS CALDERON
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Credential | D.D.S.
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Telephone | 631-666-1392
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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 | 045-794
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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