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General NPI Number Information
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NPI Number | 1962763326
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Entity Type | Organization
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Legal Business Name | RAYMOND A. DELLA PORTA, II DMD PA
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 1300 36TH ST SUITE F
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City | VERO BEACH
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State | FL
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Zip | 32960-4898
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Country | US
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Telephone | 772-567-1025
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 36TH ST SUITE F
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City | VERO BEACH
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State | FL
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Zip | 32960-4898
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Country | US
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Telephone | 772-567-1025
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RAYMOND ANTHONY DELLA PORTA II
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Credential | D.M.D
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Telephone | 772-567-1025
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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 |
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License Number State |
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