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General NPI Number Information
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NPI Number | 1720746357
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Entity Type | Organization
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Legal Business Name | COLUMBUS ENDODONTICS
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3200 MIDDLE RD
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City | COLUMBUS
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State | IN
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Zip | 47203-4426
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Country | US
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Telephone | 812-372-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 5990 HOLLOW CT
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City | BARGERSVILLE
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State | IN
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Zip | 46106-8503
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Country | US
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Telephone | 812-361-4051
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JORDON C JACOBS
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Credential | DDS, MSD
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Telephone | 812-361-4051
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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 |
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License Number State |
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