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General NPI Number Information
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NPI Number | 1649772567
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Entity Type | Organization
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Legal Business Name | GB FISHERS
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 13752 LAKERIDGE DR
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City | FISHERS
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State | IN
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Zip | 46037-7608
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Country | US
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Telephone | 317-576-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 14555 HAZEL DELL PKWY
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City | CARMEL
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State | IN
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Zip | 46033-7000
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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 | HR
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Name | TIFFANY HARTMAN
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Credential |
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Telephone | 765-662-0018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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