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General NPI Number Information
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NPI Number | 1871043018
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Entity Type | Organization
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Legal Business Name | SOUTH FAMILIA DENTAL PA
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 12720 S ORANGE BLOSSOM TRL STE 22
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City | ORLANDO
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State | FL
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Zip | 32837-6225
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Country | US
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Telephone | 407-240-2255
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Fax |
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Provider Business Mailing Address
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Address Line | 12720 S ORANGE BLOSSOM TRL STE 22
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City | ORLANDO
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State | FL
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Zip | 32837-6225
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Country | US
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Telephone | 407-240-2255
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GABRIEL JOSHUA SANGALANG
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Credential | DMD
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Telephone | 407-240-2255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN19152
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License Number State | FL
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