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General NPI Number Information
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NPI Number | 1932874260
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Entity Type | Organization
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Legal Business Name | KINCAID DENTAL CENTER
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 2655 LAKELAND DR
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City | FLOWOOD
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State | MS
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Zip | 39232-9516
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Country | US
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Telephone | 601-720-2507
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2672
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City | MADISON
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State | MS
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Zip | 39130-2672
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Country | US
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Telephone | 601-720-2507
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LATARSHA ARRINGTON
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Credential |
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Telephone | 601-720-2507
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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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