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General NPI Number Information
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NPI Number | 1821893900
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Entity Type | Individual
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Provider Name | SAMUEL DANTINNE OD
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Gender | Male
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 7305 E 35TH AVE
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City | DENVER
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State | CO
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Zip | 80238-2465
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Country | US
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Telephone | 303-320-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 620 BOSTON AVE STE 6F
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City | MEDFORD
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State | MA
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Zip | 02155-1372
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Country | US
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Telephone | 414-380-2597
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0004117
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License Number State | CO
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