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General NPI Number Information
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NPI Number | 1356675938
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Entity Type | Organization
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Legal Business Name | ASTORIA DENTAL CLINIC
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 820 NE E STREET SUITE E
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City | GRANTS PASS
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State | OR
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Zip | 97526
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Country | US
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Telephone | 541-479-7199
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Fax | 541-471-6086
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Provider Business Mailing Address
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Address Line | 820 NE E STREET SUITE E
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City | GRANTS PASS
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State | OR
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Zip | 97526
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Country | US
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Telephone | 541-479-7199
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Fax | 541-471-6086
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. BECKY EPLETT
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Credential |
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Telephone | 541-479-7199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | OR
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