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General NPI Number Information
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NPI Number | 1770825572
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Entity Type | Organization
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Legal Business Name | GEM CITY DENTAL GROUP
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Dates
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Enumeration Date | 03/20/2013
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 627 S EDWIN C. MOSES BLVD. SUITE 2A
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City | DAYTON
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State | OH
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Zip | 45417-3461
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Country | US
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Telephone | 937-938-5529
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Fax | 937-938-6754
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Provider Business Mailing Address
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Address Line | 627 S EDWIN C. MOSES BLVD. SUITE 2A
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City | DAYTON
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State | OH
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Zip | 45417-3461
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Country | US
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Telephone | 937-938-5529
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Fax | 937-938-6754
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | KATHY LOWELL
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Credential |
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Telephone | 937-938-5529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 23113
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License Number State | OH
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