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General NPI Number Information
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NPI Number | 1922200567
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Entity Type | Organization
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Legal Business Name | SOUTH CENTRAL ENDODONTICS
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 3200 MIDDLE DR
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City | COLUMBUS
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State | IN
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Zip | 47203-4426
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Country | US
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Telephone | 812-372-3636
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Fax | 812-378-3636
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Provider Business Mailing Address
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Address Line | 3200 MIDDLE DR
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City | COLUMBUS
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State | IN
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Zip | 47203-4426
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Country | US
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Telephone | 812-372-3636
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Fax | 812-378-3636
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL E. KELLER
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Credential | D.D.S. ,M.S.D.
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Telephone | 812-372-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 12008103B
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License Number State | IN
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