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General NPI Number Information
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NPI Number | 1457450165
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Entity Type | Organization
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Legal Business Name | AN-LOUISE JOHNSON DMD MD PC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 56 NEW DRIFTWAY SUITE 309
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City | SCITUATE
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State | MA
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Zip | 02066-4533
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Country | US
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Telephone | 781-545-6565
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Fax | 781-545-6597
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Provider Business Mailing Address
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Address Line | PO BOX 363
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City | SCITUATE
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State | MA
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Zip | 02066-0363
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Country | US
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Telephone | 781-545-6565
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Fax | 781-545-6597
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AN-LOUISE JOHNSON
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Credential | DMD MD
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Telephone | 781-545-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 20760
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License Number State | MA
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