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General NPI Number Information
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NPI Number | 1144596800
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Entity Type | Organization
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Legal Business Name | COMPLETE DENTAL LLC
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 2625 S RAINBOW BLVD #D100
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City | LAS VEGAS
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State | NV
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Zip | 89146-5198
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Country | US
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Telephone | 702-227-5800
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Fax | 702-227-5801
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Provider Business Mailing Address
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Address Line | 2625 S RAINBOW BLVD #D100
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City | LAS VEGAS
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State | NV
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Zip | 89146-5198
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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 | MANAGER
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Name | JONG SOOK JIN
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Credential | D.D.S
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Telephone | 702-227-5800
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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 | 4759
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License Number State | NV
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