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General NPI Number Information
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NPI Number | 1518646454
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Entity Type | Organization
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Legal Business Name | BD-CLACKAMAS, LLC
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 9225 SE SUNNYSIDE RD STE 1
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City | CLACKAMAS
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State | OR
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Zip | 97015-6703
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Country | US
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Telephone | 503-905-3380
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Fax |
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Provider Business Mailing Address
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Address Line | 9225 SE SUNNYSIDE RD STE 1
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City | CLACKAMAS
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State | OR
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Zip | 97015-6703
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Country | US
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Telephone | 503-905-3380
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Fax |
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | DEBBIE LOPEZ
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Credential |
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Telephone | 503-914-8221
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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 |
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