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General NPI Number Information
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NPI Number | 1770315111
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Entity Type | Individual
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Provider Name | CHAKRADHAR MANCHIKALAPUDI D.M.D
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Gender | Male
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Dates
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Enumeration Date | 08/15/2024
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 2625 OLD WINDER HWY STE G
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City | BRASELTON
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State | GA
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Zip | 30517-7021
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Country | US
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Telephone | 706-684-0759
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Fax |
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Provider Business Mailing Address
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Address Line | 4325 RIVERGLEN CIR
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City | SUWANEE
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State | GA
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Zip | 30024-3837
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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 |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN123564
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License Number State | GA
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