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General NPI Number Information
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NPI Number | 1104378934
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Entity Type | Individual
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Provider Name | MALCOLM AARON GOSSETT D.M.D
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Gender | Male
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 2484 BRIARCLIFF RD NE STE 29
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City | ATLANTA
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State | GA
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Zip | 30329-3011
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Country | US
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Telephone | 404-315-7385
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Fax |
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Provider Business Mailing Address
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Address Line | 303 27TH AVE
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City | SEATTLE
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State | WA
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Zip | 98122-6129
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Country | US
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Telephone | 404-551-8011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN015308
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License Number State | GA
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