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General NPI Number Information
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NPI Number | 1598219891
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Entity Type | Organization
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Legal Business Name | BEST CARE DENTAL CENTER LLC
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 1150 CRATER LAKE AVE SUITE L
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City | MEDFORD
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State | OR
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Zip | 97504-6213
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Country | US
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Telephone | 541-779-4517
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 CRATER LAKE AVE SUITE L
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City | MEDFORD
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State | OR
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Zip | 97504-6213
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Country | US
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Telephone | 541-779-4517
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Fax |
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | KIM PUTBRESE
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Credential |
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Telephone | 541-499-0292
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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 |
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License Number State |
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