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General NPI Number Information
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NPI Number | 1902897762
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Entity Type | Individual
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Provider Name | MARY ANNE DONATO FORNI D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 515 FARMERS LN
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City | SANTA ROSA
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State | CA
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Zip | 95405-4917
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Country | US
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Telephone | 707-527-8509
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Fax | 707-527-8507
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Provider Business Mailing Address
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Address Line | 515 FARMERS LN
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City | SANTA ROSA
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State | CA
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Zip | 95405-4917
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Country | US
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Telephone | 707-527-8509
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Fax | 707-527-8507
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 42995
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License Number State | CA
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