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General NPI Number Information
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NPI Number | 1952866600
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Entity Type | Organization
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Legal Business Name | INSTITUTE FOR THE TREATMENT OF CRANIOFACIAL PAIN, PA
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 2122 E ROBINSON ST
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City | ORLANDO
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State | FL
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Zip | 32803-6047
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Country | US
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Telephone | 407-963-0553
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Fax | 407-637-5183
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Provider Business Mailing Address
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Address Line | 1203 PRESERVE POINT DR
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City | WINTER PARK
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State | FL
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Zip | 32789-5939
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Country | US
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Telephone | 407-963-0553
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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. BRIAN D. FUSELIER
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Credential | DDS
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Telephone | 407-963-0553
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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 |
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License Number State |
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