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General NPI Number Information
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NPI Number | 1316245814
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Entity Type | Individual
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Provider Name | SYLVESTER CARLO III DMD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2011
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 907 PAVILION CT
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City | MCDONOUGH
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State | GA
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Zip | 30253-6665
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Country | US
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Telephone | 404-536-4322
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Fax | 770-474-4477
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Provider Business Mailing Address
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Address Line | 1740 HUDSON BRIDGE RD SUITE 1222
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6331
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Country | US
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Telephone | 404-536-4322
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Fax | 770-474-4477
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN012125
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License Number State | GA
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