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General NPI Number Information
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NPI Number | 1952891798
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Entity Type | Organization
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Legal Business Name | TWIN LAKES DENTAL CARE PLLC
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 11315 LEBANON RD
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City | MOUNT JULIET
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State | TN
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Zip | 37122
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Country | US
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Telephone | 270-839-6608
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Fax |
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Provider Business Mailing Address
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Address Line | 3127 LONG BLVD APT 308
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City | NASHVILLE
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State | TN
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Zip | 37203-2077
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Country | US
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Telephone | 270-839-6608
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT STEPHEN BOH
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Credential | DMD
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Telephone | 270-839-6608
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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 | 10219
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License Number State | TN
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