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General NPI Number Information
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NPI Number | 1942747183
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Entity Type | Organization
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Legal Business Name | JOHN W. LECLAIR DMD
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 1315 W COLLEGE AVE SUITE 201
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City | STATE COLLEGE
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State | PA
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Zip | 16801-2776
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Country | US
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Telephone | 814-954-7620
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Fax | 814-308-9985
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Provider Business Mailing Address
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Address Line | 1315 W COLLEGE AVE SUITE 201
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City | STATE COLLEGE
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State | PA
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Zip | 16801-2776
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Country | US
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Telephone | 814-954-7620
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Fax | 814-308-9985
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Authorized Official
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Title or Position | OWNER
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Name | JOHN W LECLAIR
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Credential | D.M.D.
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Telephone | 814-441-4432
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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 | DS017092L
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License Number State | PA
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