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General NPI Number Information
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NPI Number | 1154076339
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Entity Type | Organization
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Legal Business Name | LEMIRE DENTAL CORPORATION
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 14650 AVIATION BLVD STE 185
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City | HAWTHORNE
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State | CA
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Zip | 90250-6665
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Country | US
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Telephone | 310-643-9711
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Fax |
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Provider Business Mailing Address
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Address Line | 810 KNOB HILL AVE
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City | REDONDO BEACH
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State | CA
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Zip | 90277-4347
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Country | US
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Telephone | 214-738-0420
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KIM LEMIRE
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Credential | DMD
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Telephone | 147-380-4202
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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 |
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License Number State |
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