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General NPI Number Information
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NPI Number | 1649661885
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Entity Type | Organization
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Legal Business Name | KENNETH G EDWARDS
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 109 PONEMAH RD
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City | AMHERST
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State | NH
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Zip | 03031-2834
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Country | US
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Telephone | 603-673-0782
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Fax | 603-673-4747
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Provider Business Mailing Address
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Address Line | PO BOX 926
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City | AMHERST
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State | NH
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Zip | 03031-0926
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Country | US
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Telephone | 603-673-0782
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Fax | 603-673-4747
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH G EDWARDS
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Credential | DDS
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Telephone | 603-673-0782
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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 | 01693
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License Number State | NH
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