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General NPI Number Information
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NPI Number | 1841641040
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Entity Type | Organization
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Legal Business Name | MAYNARD, LLC
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Dates
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Enumeration Date | 06/29/2016
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 821 KING GEORGE BLVD SUITE A
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City | SAVANNAH
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State | GA
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Zip | 31419-8328
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Country | US
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Telephone | 912-927-8484
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Fax | 912-927-8487
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Provider Business Mailing Address
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Address Line | PO BOX 13989
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City | SAVANNAH
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State | GA
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Zip | 31416-0989
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Country | US
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Telephone | 912-927-8484
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Fax | 912-927-8487
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROY MAYNARD JR.
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Credential | DDS
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Telephone | 912-927-8484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN014449
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License Number State | GA
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