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General NPI Number Information
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NPI Number | 1962663203
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Entity Type | Organization
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Legal Business Name | POST OFFICE LAKE DENTAL ASSOCIATES
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 603 POST OFFICE RD STE 208
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City | WALDORF
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State | MD
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Zip | 20602-1914
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Country | US
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Telephone | 301-870-7077
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Fax | 301-843-8030
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Provider Business Mailing Address
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Address Line | 603 POST OFFICE RD STE 208
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City | WALDORF
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State | MD
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Zip | 20602-1914
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Country | US
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Telephone | 301-870-7077
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Fax | 301-843-8030
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Authorized Official
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Title or Position | OFFICE CONTACT
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Name | MRS. KAMEASA LAVONNE JOHNSON
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Credential |
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Telephone | 301-870-7077
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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 | 10857
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License Number State | MD
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