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General NPI Number Information
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NPI Number | 1346452315
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Entity Type | Individual
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Provider Name | MARION WAYNE HARDISON DMD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 7203 PRESTON HWY
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City | LOUISVILLE
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State | KY
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Zip | 40219-2707
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Country | US
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Telephone | 502-966-5777
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Fax |
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Provider Business Mailing Address
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Address Line | 18713 WEATHERFORD CIR
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City | LOUISVILLE
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State | KY
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Zip | 40245-6225
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Country | US
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Telephone | 502-966-5777
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7052
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License Number State | KY
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