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General NPI Number Information
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NPI Number | 1710358700
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Entity Type | Organization
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Legal Business Name | BURLEY ENDODONTICS, LLC
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 10/15/2015
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Provider Practice Location Address
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Address Line | 30485 SW BOONES FERRY RD SUITE 103
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City | WILSONVILLE
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State | OR
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Zip | 97070-7845
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Country | US
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Telephone | 503-698-7268
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Fax |
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Provider Business Mailing Address
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Address Line | 30485 SW BOONES FERRY RD SUITE 103
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City | WILSONVILLE
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State | OR
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Zip | 97070-7845
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Country | US
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Telephone | 503-698-7268
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JARID ANDREW BURLEY
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Credential | DMD
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Telephone | 503-570-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D9148
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D9976
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License Number State | OR
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