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General NPI Number Information
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NPI Number | 1811416407
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY DENTAL CARE INC
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 613 AMHERST ST
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City | NASHUA
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State | NH
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Zip | 03063-1017
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Country | US
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Telephone | 603-882-3885
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Fax |
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Provider Business Mailing Address
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Address Line | 613 AMHERST ST
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City | NASHUA
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State | NH
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Zip | 03063-1017
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Country | US
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Telephone | 603-882-3885
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRAVEENA P BHAT
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Credential | DMD
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Telephone | 603-264-1445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 03841
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License Number State | NH
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