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ANNE G. SANTA DDS, INC. Notice of Privacy Practices Acknowledgement of Receipt Form Patient Name: (Please Print)Date of Birth: Parent / Personal Representative (If Applicable):(Please Print)I hereby
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Anne G. Banta DDS is likely a reference to a dental practice or an individual dentist, providing dental care services.
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The purpose of the Anne G. Banta DDS documentation may involve the reporting of dental practice information, compliance with state or federal regulations, or personal record-keeping.
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