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General NPI Number Information
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NPI Number | 1538330444
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Entity Type | Organization
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Legal Business Name | FLORENCE DENTAL CLINIC
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 129 EARL CLARK DRIVE
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City | FLORENCE
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State | MS
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Zip | 39073
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Country | US
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Telephone | 601-845-2386
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Fax | 601-845-1470
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Provider Business Mailing Address
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Address Line | PO BOX 97632
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City | JACKSON
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State | MS
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Zip | 39288-7632
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Country | US
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Telephone | 601-845-2386
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Fax | 601-845-1470
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. THOMAS R BYRD
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Credential | DMD
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Telephone | 604-845-2386
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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 | 3182
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2401
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License Number State | MS
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