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General NPI Number Information
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NPI Number | 1043670391
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Entity Type | Individual
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Provider Name | ROD ALI ERFANI DMD
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Gender | Male
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 2215 PORTLAND AVE
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City | LOUISVILLE
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State | KY
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Zip | 40212
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Country | US
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Telephone | 502-772-8160
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Fax | 502-772-8108
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Provider Business Mailing Address
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Address Line | PO BOX 950244
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City | LOUISVILLE
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State | KY
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Zip | 40295-0244
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Country | US
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Telephone | 812-218-8926
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Fax | 812-218-8930
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 10177
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License Number State | KY
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