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Individual
MODOMI J. ROMAN LEBRON
Active
Individual
MODOMI J. ROMAN LEBRON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
007527
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196237
REGISTRY CERTIFICATE
PR
Enumeration date
08/18/2017
Last updated
06/16/2018
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