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General NPI Number Information
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NPI Number | 1790229383
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Entity Type | Organization
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Legal Business Name | HALES DENTAL PRACTICE, PC
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Dates
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Enumeration Date | 12/15/2016
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 781 NE 7TH ST B
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City | GRANTS PASS
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State | OR
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Zip | 97526-1654
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Country | US
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Telephone | 541-474-1100
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Fax | 541-474-1103
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Provider Business Mailing Address
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Address Line | 781 NE 7TH ST B
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City | GRANTS PASS
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State | OR
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Zip | 97526-1654
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Country | US
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Telephone | 541-474-1100
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Fax | 541-474-1103
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JIM B HALES
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Credential | DDS
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Telephone | 541-474-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | D6777
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D6777
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License Number State | OR
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