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General NPI Number Information
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NPI Number | 1336744127
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Entity Type | Organization
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Legal Business Name | LEGACY DENTAL PC
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 409 POND ST STE 7
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City | BRAINTREE
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State | MA
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Zip | 02184-6853
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Country | US
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Telephone | 781-843-7570
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Fax | 781-843-3574
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Provider Business Mailing Address
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Address Line | 409 POND ST STE 7
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City | BRAINTREE
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State | MA
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Zip | 02184-6853
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Country | US
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Telephone | 781-843-7570
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Fax | 781-843-3574
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Authorized Official
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Title or Position | DENTIST
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Name | DR. EARL R MARROW III
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Credential | DMD
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Telephone | 781-843-7570
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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 |
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License Number State |
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