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General NPI Number Information
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NPI Number | 1114156643
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Entity Type | Individual
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Provider Name | JAMIE ANN DE STEFANO DMD, PHD
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Gender | Female
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 1459 LANEY WALKER BLVD MCG SOD AD 2809
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City | AUGUSTA
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State | GA
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Zip | 30912-2809
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Country | US
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Telephone | 706-721-2441
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Fax |
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Provider Business Mailing Address
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Address Line | 7 EAGLE POINTE DR
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City | AUGUSTA
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State | GA
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Zip | 30909-6057
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Country | US
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Telephone | 706-667-6778
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Fax | 706-667-6778
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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 | DN012409
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8157
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License Number State | KY
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