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General NPI Number Information
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NPI Number | 1609346949
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Entity Type | Organization
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Legal Business Name | MARION ORAL & MAXILLOFACIAL SURGERY, LLC
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Dates
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Enumeration Date | 11/29/2018
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Last Update Date | 11/29/2018
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Provider Practice Location Address
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Address Line | 702 N RIVER DR
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City | MARION
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State | IN
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Zip | 46952-2647
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Country | US
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Telephone | 765-664-1076
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Fax |
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Provider Business Mailing Address
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Address Line | 11555 BELMONT CT
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City | CARMEL
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State | IN
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Zip | 46032-8680
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Country | US
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Telephone | 317-453-1980
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Fax |
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Authorized Official
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Title or Position | PRACTICE CO-OWNER
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Name | DR. HARRY PAPADOPOULOS
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Credential | DDS, MD
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Telephone | 317-453-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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