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Individual
ALEX TAVASOLI
Active
Individual
ALEX TAVASOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.034424
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019.034424
IL
Other
Enumeration date
05/15/2023
Last updated
04/19/2026
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