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General NPI Number Information
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NPI Number | 1952452211
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Entity Type | Individual
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Provider Name | DEMETRICK WAYNE LECORN D.M.D., M.S.
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Gender | Male
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2130 SW 22ND PL # 101
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City | OCALA
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State | FL
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Zip | 34474-7065
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Country | US
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Telephone | 352-291-9360
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Fax | 352-291-9363
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Provider Business Mailing Address
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Address Line | 2130 SW 22ND PL # 101
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City | OCALA
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State | FL
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Zip | 34474-7065
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Country | US
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Telephone | 352-291-9360
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Fax | 352-291-9363
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN16008
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License Number State | FL
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