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General NPI Number Information
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NPI Number | 1831476183
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Entity Type | Organization
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Legal Business Name | MY FAMILY DENTAL CARE, P.C.
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 6223 DEMPSTER ST
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City | MORTON GROVE
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State | IL
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Zip | 60053-2818
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Country | US
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Telephone | 224-534-7123
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Fax | 224-534-7214
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Provider Business Mailing Address
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Address Line | 6223 DEMPSTER ST
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City | MORTON GROVE
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State | IL
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Zip | 60053-2818
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Country | US
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Telephone | 224-534-7123
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Fax | 224-534-7214
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SANDY CERTEZA
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Credential |
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Telephone | 630-456-3832
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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 | 019018019
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License Number State | IL
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