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Individual
NGA VAN
Active
Individual
NGA VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN17986
FL
Other
Enumeration date
07/17/2007
Last updated
07/15/2010
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