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General NPI Number Information
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NPI Number | 1619188158
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Entity Type | Individual
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Provider Name | LAWRENCE FALES AYERS III DDS
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Gender | Male
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7120 HERITAGE VILLAGE PLZ SUITE 101
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City | GAINESVILLE
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State | VA
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Zip | 20155-3067
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Country | US
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Telephone | 703-754-8809
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Fax | 703-753-9066
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Provider Business Mailing Address
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Address Line | 6757 LAKE DR
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City | WARRENTON
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State | VA
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Zip | 20187-2546
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Country | US
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Telephone | 540-349-8694
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0401006596
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License Number State | VA
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