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General NPI Number Information
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NPI Number | 1104108612
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Entity Type | Organization
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Legal Business Name | AUSTIN POOLE, DMD, PLLC
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 705 S CHOCTAW ST
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City | CLARKSDALE
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State | MS
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Zip | 38614-4810
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Country | US
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Telephone | 662-627-7324
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Fax | 662-627-7325
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Provider Business Mailing Address
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Address Line | 705 CHOCTAW SOUTH
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City | CLARKSDALE
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State | MS
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Zip | 38614
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Country | US
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Telephone | 662-627-7324
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Fax | 662-627-7325
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Authorized Official
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Title or Position | OWNER
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Name | DR. AUSTIN POOLE
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Credential | D.M.D
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Telephone | 662-627-7324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3239-02
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License Number State | MS
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