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General NPI Number Information
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NPI Number | 1538682869
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Entity Type | Organization
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Legal Business Name | FAMILY & IMPLANT DENTISTRY OF DALE, LLC
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/19/2017
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Provider Practice Location Address
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Address Line | 110 W HAMMOND ST
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City | DALE
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State | IN
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Zip | 47523-8965
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Country | US
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Telephone | 812-937-4818
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 465
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City | DALE
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State | IN
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Zip | 47523-0465
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Country | US
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Telephone | 812-937-4818
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALAN PAUL FRIZ
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Credential | DDS
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Telephone | 812-937-4818
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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 | 12008787A
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License Number State | IN
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