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General NPI Number Information
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NPI Number | 1922854587
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Entity Type | Individual
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Provider Name | DR. MERNA MICHEAL BASELIOUS
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Gender | Female
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Dates
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Enumeration Date | 04/25/2024
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 7554 S US HIGHWAY 1 STE 13
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-1450
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Country | US
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Telephone | 772-242-4124
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Fax |
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Provider Business Mailing Address
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Address Line | 47 DOGWOOD CIR
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City | WEST LEBANON
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State | NH
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Zip | 03784-1749
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Country | US
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Telephone | 802-356-9700
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN30053
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License Number State | FL
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