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General NPI Number Information
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NPI Number | 1598113540
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Entity Type | Organization
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Legal Business Name | JOSEPH BOONE DMD PC
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 128 RIVERVIEW DR
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City | FLOWOOD
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State | MS
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Zip | 39232-8908
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Country | US
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Telephone | 601-664-9981
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Fax |
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Provider Business Mailing Address
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Address Line | 128 RIVERVIEW DR
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City | FLOWOOD
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State | MS
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Zip | 39232-8908
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Country | US
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Telephone | 601-664-9981
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | JOSEPH BOONE
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Credential | DMD
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Telephone | 601-664-9981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3717-13
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License Number State | MS
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