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General NPI Number Information
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NPI Number | 1922597921
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Entity Type | Organization
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Legal Business Name | CG DENTAL CARE
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 11438 LEBANON RD UNIT A
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City | SHARONVILLE
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State | OH
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Zip | 45241-6201
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Country | US
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Telephone | 513-738-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 1097 BEAR GRASS WAY
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City | MAINEVILLE
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State | OH
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Zip | 45039-7003
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Country | US
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Telephone | 857-206-4448
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | WILLIAM H CASTELLANOS
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Credential |
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Telephone | 857-206-4448
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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 |
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License Number State |
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