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General NPI Number Information
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NPI Number | 1821146820
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Entity Type | Organization
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Legal Business Name | COASTAL DENTURE CLINIC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1647 W 12TH ST.
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City | FLORENCE
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State | OR
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Zip | 97439
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Country | US
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Telephone | 541-997-3344
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Fax | 541-997-9103
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Provider Business Mailing Address
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Address Line | PO BOX 38000
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City | FLORENCE
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State | OR
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Zip | 97439-0161
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Country | US
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Telephone | 541-997-3344
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Fax | 541-997-9103
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHAWN M MURRAY
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Credential | C.D.T., L.D.
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Telephone | 541-997-3344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | 0516846206
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License Number State | OR
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