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General NPI Number Information
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NPI Number | 1386794626
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Entity Type | Individual
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Provider Name | CARRIE BULLACK LAIRD DMD
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15125 SW BEARD ROAD
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City | BEAVERTON
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State | OR
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Zip | 97007
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Country | US
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Telephone | 503-590-4300
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Fax | 503-590-0269
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Provider Business Mailing Address
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Address Line | 2275 GLEN HAVEN ROAD
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City | LAKE OWESGO
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State | OR
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Zip | 97034
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Country | US
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Telephone | 971-998-6383
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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 | 8767
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License Number State | OR
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