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General NPI Number Information
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NPI Number | 1902351539
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Entity Type | Organization
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Legal Business Name | CENTER FOR DENTAL EXCELLENCE, LLC
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 14 BRACE RD
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City | WEST HARTFORD
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State | CT
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Zip | 06107-1801
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Country | US
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Telephone | 860-521-7129
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Fax | 860-521-7736
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Provider Business Mailing Address
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Address Line | 14 BRACE RD
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City | WEST HARTFORD
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State | CT
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Zip | 06107-1801
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Country | US
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Telephone | 860-521-7129
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Fax | 860-521-7736
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Authorized Official
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Title or Position | MEMBER
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Name | DR. LAWRENCE S CHRISTIAN
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Credential | D.M.D.
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Telephone | 860-521-7129
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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 | CT
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