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General NPI Number Information
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NPI Number | 1942738901
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Entity Type | Organization
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Legal Business Name | LOCAL DENTAL PARTNERS, LLC
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Dates
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Enumeration Date | 06/02/2017
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Last Update Date | 07/14/2017
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Provider Practice Location Address
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Address Line | 4353 ATLANTA HIGHWAY SUITE. 300
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City | LOGANVILLE
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State | GA
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Zip | 30052
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Country | US
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Telephone | 770-405-2030
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Fax |
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Provider Business Mailing Address
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Address Line | 4353 ATLANTA HWY STE 300
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City | LOGANVILLE
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State | GA
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Zip | 30052-3232
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Country | US
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Telephone | 770-405-2030
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING ADMINISTRATOR
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Name | ASHLEY NICHELLE THOMAS
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Credential |
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Telephone | 770-450-2030
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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 | DN013645
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License Number State | GA
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