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General NPI Number Information
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NPI Number | 1043081789
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Entity Type | Organization
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Legal Business Name | WESTSIDE ENDODONTICS LLC
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Dates
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Enumeration Date | 01/11/2024
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 730 PATRICK PL
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City | BROWNSBURG
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State | IN
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Zip | 46112-2112
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Country | US
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Telephone | 317-750-8209
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 N COLLEGE AVE APT 2
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-1754
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Country | US
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Telephone | 317-750-8209
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KARA BROTHERS
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Credential | DMD, MSD
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Telephone | 317-750-8209
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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 |
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License Number State |
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