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General NPI Number Information
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NPI Number | 1811215122
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Entity Type | Individual
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Provider Name | GENE S LEE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 325 ADAMS DR. SUITE 335
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City | WEATHERFORD
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State | TX
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Zip | 76086
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Country | US
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Telephone | 817-594-5888
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Fax | 817-594-6266
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Provider Business Mailing Address
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Address Line | 609 CABRAL CIRCLE #4207
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City | FORT WORTH
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State | TX
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Zip | 76102
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Country | US
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Telephone | 510-847-0161
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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 | 27442
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DT-2401
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License Number State | HI
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