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General NPI Number Information
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NPI Number | 1265720593
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Entity Type | Individual
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Provider Name | GARY L NELSON DMD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 9925 HAYNES BRIDGE RD SUITE 700
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City | JOHNS CREEK
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State | GA
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Zip | 30022-8532
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Country | US
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Telephone | 470-297-6700
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Fax | 470-297-6693
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Provider Business Mailing Address
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Address Line | 9925 HAYNES BRIDGE RD SUITE 700
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City | JOHNS CREEK
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State | GA
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Zip | 30022-8532
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Country | US
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Telephone | 470-297-6700
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Fax | 470-297-6693
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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 | DN014907
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License Number State | GA
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