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General NPI Number Information
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NPI Number | 1851412613
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Entity Type | Individual
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Provider Name | JOHN K GROTHE DMD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8454 NORTHCLIFFE BLVD LAKESIDE FAMILY DENTAL CARE
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City | SPRING HILL
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State | FL
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Zip | 34606-1140
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Country | US
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Telephone | 352-686-1122
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Fax | 352-688-8693
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Provider Business Mailing Address
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Address Line | 8454 NORTHCLIFFE BLVD LAKESIDE FAMILY DENTAL CARE
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City | SPRING HILL
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State | FL
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Zip | 34606
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Country | US
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Telephone | 352-686-1122
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Fax | 352-688-8693
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN014448
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License Number State | FL
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