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General NPI Number Information
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NPI Number | 1871028159
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Entity Type | Organization
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Legal Business Name | COMPLETE FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/25/2017
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 9635 KOI ROCK DR
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City | LINCOLN
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State | NE
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Zip | 68526-9678
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Country | US
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Telephone | 402-499-0624
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Fax |
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Provider Business Mailing Address
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Address Line | 9635 KOI ROCK DR
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City | LINCOLN
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State | NE
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Zip | 68526-9678
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Country | US
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Telephone | 402-499-0624
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | FARRAH PLATE
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Credential | DR.
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Telephone | 402-499-0624
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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 | 6546
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License Number State | NE
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