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General NPI Number Information
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NPI Number | 1841625910
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Entity Type | Organization
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Legal Business Name | MIDPOINT DENTISTRY
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 7117 CONGDON RD SUITE 100
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City | FORT MYERS
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State | FL
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Zip | 33908-4216
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Country | US
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Telephone | 239-418-1444
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Fax | 239-418-1888
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Provider Business Mailing Address
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Address Line | 7117 CONGDON RD SUITE 100
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City | FORT MYERS
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State | FL
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Zip | 33908-4216
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Country | US
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Telephone | 239-418-1444
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Fax | 239-418-1888
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. OLIVER P FAVALLI
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Credential |
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Telephone | 239-418-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN13738
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License Number State | FL
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