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General NPI Number Information
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NPI Number | 1821340308
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Entity Type | Organization
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Legal Business Name | ENDODONCIA DEL NORESTE, PSC
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | ROBERTO CLEMENTE AVENUE ESQ CALLE 99 BLOQUE 89 #1
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City | CAROLINA
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State | PR
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Zip | 00985
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Country | US
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Telephone | 787-757-0548
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Fax |
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Provider Business Mailing Address
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Address Line | 60 CALLE CRISTOBAL COLON
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City | YABUCOA
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State | PR
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Zip | 00767-3616
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DMD/ ENDODONTIST
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Name | DR. GABRIEL FUENTES-ARROYO
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Credential |
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Telephone | 787-757-0548
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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 | 2869
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License Number State | PR
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