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General NPI Number Information
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NPI Number | 1710422209
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Entity Type | Organization
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Legal Business Name | LAK DDS LLC
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Dates
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Enumeration Date | 12/20/2016
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Last Update Date | 03/17/2017
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Provider Practice Location Address
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Address Line | 14560 RIVER RD SUITE 105
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City | CARMEL
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State | IN
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Zip | 46033-5801
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Country | US
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Telephone | 317-764-2938
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Fax | 317-219-6781
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Provider Business Mailing Address
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Address Line | 14560 RIVER RD STE 105
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City | CARMEL
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State | IN
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Zip | 46033-5802
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Country | US
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Telephone | 317-764-2938
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Fax | 317-219-6781
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Authorized Official
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Title or Position | DDS
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Name | LOUIS ABUKHALAF
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Credential |
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Telephone | 312-375-5306
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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 | 12011660
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License Number State | IN
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