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General NPI Number Information
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NPI Number | 1912907064
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Entity Type | Individual
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Provider Name | MICHAEL LAWRENCE GAGE DDS PS
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Gender | Male
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 10/27/2008
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Provider Practice Location Address
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Address Line | 2520 N ALDER ST
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City | TACOMA
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State | WA
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Zip | 98406-6632
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Country | US
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Telephone | 253-759-5414
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Fax | 253-756-6860
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Provider Business Mailing Address
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Address Line | 2520 N ALDER ST
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City | TACOMA
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State | WA
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Zip | 98406-6632
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Country | US
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Telephone | 253-759-5414
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Fax | 253-756-6860
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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 | 4344
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License Number State | WA
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