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General NPI Number Information
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NPI Number | 1245404714
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Entity Type | Individual
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Provider Name | JEFFREY KENT WATERS D.M.D., M.S.
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Gender | Male
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 2680 LAWRENCEVILLE HWY SUITE 102
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City | DECATUR
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State | GA
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Zip | 30033-2500
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Country | US
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Telephone | 678-990-8034
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Fax | 770-934-7176
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Provider Business Mailing Address
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Address Line | 2680 LAWRENCEVILLE HWY SUITE 102
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City | DECATUR
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State | GA
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Zip | 30033-2500
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Country | US
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Telephone | 678-990-8034
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Fax | 770-934-7176
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN013125
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License Number State | GA
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