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General NPI Number Information
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NPI Number | 1972075760
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Entity Type | Organization
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Legal Business Name | ORTHODONTIC ASSOCIATES LLC
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Dates
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Enumeration Date | 12/18/2018
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 505 FRONT ST STE 202
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City | LAHAINA
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State | HI
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Zip | 96761
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Country | US
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Telephone | 808-874-9229
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Fax | 808-961-2805
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Provider Business Mailing Address
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Address Line | 285 W KAAHUMANU AVE STE 220
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City | KAHULUI
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State | HI
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Zip | 96732-1623
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Country | US
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Telephone | 808-874-9229
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | ALEXANDER VERGA
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Credential |
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Telephone | 808-961-6662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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