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General NPI Number Information
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NPI Number | 1851596555
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Entity Type | Individual
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Provider Name | ANDRE T CARDOSO D.M.D., M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 7334 BUCKLEY RD
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-2600
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Country | US
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Telephone | 315-458-8680
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Fax |
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Provider Business Mailing Address
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Address Line | 4322 KELSEY DR
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City | SYRACUSE
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State | NY
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Zip | 13215-1256
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Country | US
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Telephone | 917-692-6301
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 050299
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 241657
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License Number State | NY
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