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General NPI Number Information
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NPI Number | 1871857334
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Entity Type | Individual
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Provider Name | LANCE E. ANDERSON DMD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 240 E MAIN ST
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City | LOVELL
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State | WY
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Zip | 82431-2102
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Country | US
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Telephone | 307-548-7654
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Fax | 307-333-0345
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Provider Business Mailing Address
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Address Line | 2019 WILLIAM ST
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City | GRAND ISLAND
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State | NE
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Zip | 68801-7432
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Country | US
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Telephone | 307-751-0925
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Fax |
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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 | 1305
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License Number State | WY
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