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General NPI Number Information
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NPI Number | 1619846656
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Entity Type | Organization
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Legal Business Name | BAY BREEZE DENTAL GROUP
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 520A COURTHOUSE RD
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City | GULFPORT
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State | MS
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Zip | 39507-2503
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Country | US
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Telephone | 228-896-6973
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Fax |
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Provider Business Mailing Address
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Address Line | 11546 BRIARSTONE PL
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City | GULFPORT
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State | MS
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Zip | 39503-6170
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. SCARLETT LAREE JOHNSON
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Credential | DMD
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Telephone | 415-235-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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