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General NPI Number Information
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NPI Number | 1962951772
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Entity Type | Individual
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Provider Name | AMAL LATTOUF D.M.D
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Gender | Female
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 1478 POST RD
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City | FAIRFIELD
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State | CT
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Zip | 06824-5938
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Country | US
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Telephone | 646-692-6670
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Fax |
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Provider Business Mailing Address
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Address Line | 10 KEELERS RIDGE RD
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City | WILTON
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State | CT
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Zip | 06897-1607
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Country | US
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Telephone | 404-543-6677
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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 | 50-058814
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 13422
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License Number State | CT
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