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General NPI Number Information
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NPI Number | 1831898105
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Entity Type | Individual
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Provider Name | VIVEK VISWANATH DDS
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Gender | Male
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 160 COMMACK RD
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City | COMMACK
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State | NY
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Zip | 11725-3412
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Country | US
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Telephone | 631-499-6999
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Fax |
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Provider Business Mailing Address
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Address Line | 62 STRATHMORE VILLAGE DR
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720-1228
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Country | US
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Telephone | 408-220-3521
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 064214
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License Number State | NY
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