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General NPI Number Information
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NPI Number | 1891308029
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Entity Type | Organization
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Legal Business Name | MAGNOLIA GROVE CITY LLC
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Dates
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Enumeration Date | 08/27/2020
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 2053 STRINGTOWN RD
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City | GROVE CITY
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State | OH
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Zip | 43123-2930
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Country | US
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Telephone | 614-636-4081
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Fax |
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Provider Business Mailing Address
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Address Line | 2053 STRINGTOWN RD
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City | GROVE CITY
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State | OH
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Zip | 43123-2930
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGIONAL OPERATIONS MANAGER
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Name | JENNIFER SAMMONS
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Credential |
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Telephone | 937-203-1163
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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 |
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License Number State |
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