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General NPI Number Information
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NPI Number | 1861685968
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Entity Type | Organization
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Legal Business Name | CINCINNATI ORAL & MAXILLOFACIAL SURGERY ASSOC., INC.
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 7803 5 MILE RD
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City | CINCINNATI
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State | OH
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Zip | 45230-2347
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Country | US
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Telephone | 513-624-0055
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Fax |
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Provider Business Mailing Address
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Address Line | 7141 MIAMI AVE 202
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City | CINCINNATI
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State | OH
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Zip | 45243-2616
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES P CASSIDY
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Credential | DDS
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Telephone | 513-624-0055
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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 | 30017898
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License Number State | OH
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