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General NPI Number Information
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NPI Number | 1417351289
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Entity Type | Organization
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Legal Business Name | SIFFRARD FAMILY DENTISTRY, PLLC
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 6760 GOODMAN RD
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City | OLIVE BRANCH
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State | MS
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Zip | 38654
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Country | US
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Telephone | 662-895-3000
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Fax | 662-895-3021
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Provider Business Mailing Address
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Address Line | 6760 GOODMAN RD
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City | OLIVE BRANCH
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State | MS
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Zip | 38654
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Country | US
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Telephone | 662-895-3000
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Fax | 662-895-3021
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JANITA ALEXANDER SIFFRARD
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Credential | D.D.S.
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Telephone | 662-895-3000
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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 | 3686-13
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 348908
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License Number State | MS
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