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General NPI Number Information
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NPI Number | 1528125242
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Entity Type | Individual
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Provider Name | ANDREW THOMAS SHIELDS III DMD
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 653 N TOWN CENTER DR SUITE 508
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City | LAS VEGAS
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State | NV
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Zip | 89144-0514
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Country | US
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Telephone | 702-228-8777
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Fax | 702-228-6452
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Provider Business Mailing Address
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Address Line | 267 CAMINO VIEJO ST
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City | HENDERSON
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State | NV
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Zip | 89012-4818
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Country | US
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Telephone | 702-302-6449
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Fax | 702-228-6452
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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 | 4635
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License Number State | NV
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