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General NPI Number Information
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NPI Number | 1821520776
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Entity Type | Organization
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Legal Business Name | ULTRA ENDODONTICS, LLC
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 7198 CHAPMAN DR SUITE 7
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City | HAYES
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State | VA
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Zip | 23072-3416
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Country | US
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Telephone | 757-250-5285
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Fax |
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Provider Business Mailing Address
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Address Line | 1092 BLUE CASTLE LN
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-1939
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Country | US
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Telephone | 206-335-4494
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Fax | 757-315-8180
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Authorized Official
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Title or Position | OWNER/ENDODONTIST
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Name | ENRIQUE OLTRA ESPLUGUES
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Credential | DDS, MSD
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Telephone | 757-250-5285
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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 | 0401414309
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License Number State | VA
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