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General NPI Number Information
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NPI Number | 1891806444
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Entity Type | Individual
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Provider Name | BEOM J LEE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4855 RIVER GREEN PKWY SUITE 110
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City | DULUTH
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State | GA
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Zip | 30096-8336
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Country | US
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Telephone | 770-500-3757
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Fax | 770-476-4995
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Provider Business Mailing Address
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Address Line | 4855 RIVER GREEN PKWY SUITE 110
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City | DULUTH
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State | GA
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Zip | 30096-8336
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Country | US
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Telephone | 770-500-3757
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Fax | 770-476-4995
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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 | DN013393
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License Number State | GA
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