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General NPI Number Information
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NPI Number | 1821155318
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Entity Type | Organization
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Legal Business Name | RESTON DENTAL GROUP, PC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 20955 PROFESSIONAL PLZ STE 110
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City | ASHBURN
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State | VA
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Zip | 20147-3405
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Country | US
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Telephone | 703-723-0014
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Fax | 703-723-0949
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Provider Business Mailing Address
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Address Line | 20955 PROFESSIONAL PLZ STE 110
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City | ASHBURN
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State | VA
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Zip | 20147-3405
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Country | US
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Telephone | 703-723-0014
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Fax | 703-723-0949
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | HANNAH FISH
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Credential |
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Telephone | 217-540-5699
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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 |
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License Number State | MD
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