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General NPI Number Information
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NPI Number | 1043571672
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Entity Type | Organization
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Legal Business Name | PHDENTALPC
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 05/30/2012
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Provider Practice Location Address
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Address Line | 2859 PACES FERRY RD SE SUITE 530
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City | ATLANTA
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State | GA
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Zip | 30339-5701
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Country | US
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Telephone | 678-355-8980
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Fax | 770-405-8855
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Provider Business Mailing Address
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Address Line | 2859 PACES FERRY RD SE SUITE 530
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City | ATLANTA
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State | GA
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Zip | 30339-5701
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Country | US
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Telephone | 678-355-8980
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Fax | 770-405-8855
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Authorized Official
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Title or Position | OWNER
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Name | DR. HAROLD PEREZ
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Credential |
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Telephone | 678-355-8980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN12114
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License Number State | GA
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