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General NPI Number Information
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NPI Number | 1134275910
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Entity Type | Individual
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Provider Name | KAREN GRACE SAMUELS DDS
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 200 E PONCE DE LEON AVE STE 300
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City | DECATUR
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State | GA
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Zip | 30030-3469
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Country | US
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Telephone | 470-857-7322
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Fax |
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Provider Business Mailing Address
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Address Line | 29777 TELEGRAPH RD STE 3000
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City | SOUTHFIELD
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State | MI
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Zip | 48034-7634
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Country | US
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Telephone |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN011277
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License Number State | GA
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