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General NPI Number Information
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NPI Number | 1902265036
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Entity Type | Organization
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Legal Business Name | CITY DENTISTRY
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 2090 7TH AVE GROUND FLOOR
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City | NEW YORK
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State | NY
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Zip | 10027-4990
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Country | US
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Telephone | 201-572-9028
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Fax |
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Provider Business Mailing Address
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Address Line | 56 CORNELL DR
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5519
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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 | OWNER
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Name | DR. GRAIG ADAM FISCHGRUND
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Credential | DMD
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Telephone | 201-572-9028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 056265
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License Number State | NY
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