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General NPI Number Information
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NPI Number | 1841461126
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Entity Type | Organization
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Legal Business Name | DESERT SUN ENDODONTICS
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 4025 W BELL RD SUITE #11
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City | PHOENIX
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State | AZ
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Zip | 85053-2750
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Country | US
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Telephone | 602-354-3944
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Fax |
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Provider Business Mailing Address
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Address Line | 4025 W BELL RD SUITE #11
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City | PHOENIX
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State | AZ
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Zip | 85053-2750
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Country | US
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Telephone | 602-354-3944
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Fax |
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Authorized Official
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Title or Position | OWNER / PARTNER
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Name | DR. JASON R BOOTH
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Credential | D.M.D
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Telephone | 602-354-3944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D5887
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D5542
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License Number State | AZ
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