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General NPI Number Information
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NPI Number | 1689891277
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Entity Type | Individual
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Provider Name | LANCE CAMERON FOGLE DMD
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 1405 BRUSHY CREEK RD
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City | TAYLORS
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State | SC
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Zip | 29687-4008
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Country | US
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Telephone | 864-284-9466
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Fax |
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Provider Business Mailing Address
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Address Line | 110 VILLA RD
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City | GREENVILLE
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State | SC
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Zip | 29615-3010
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Country | US
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Telephone | 864-282-1935
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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 | 3659
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 717
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License Number State | SC
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