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General NPI Number Information
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NPI Number | 1558595777
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Entity Type | Organization
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Legal Business Name | DENTURES ONLY P.C.
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 05/04/2009
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Provider Practice Location Address
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Address Line | 1445 W HOOSIER BLVD STE 103
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City | PERU
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State | IN
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Zip | 46970-3727
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Country | US
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Telephone | 765-689-7096
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Fax |
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Provider Business Mailing Address
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Address Line | 1445 W HOOSIER BLVD STE 103
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City | PERU
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State | IN
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Zip | 46970-3727
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Country | US
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Telephone | 765-689-7096
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN R. LADD
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Credential | DDS
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Telephone | 765-455-0085
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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 | 7549
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License Number State | IN
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