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General NPI Number Information
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NPI Number | 1053493783
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Entity Type | Individual
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Provider Name | DOUGLAS LEE WIRTH DMD
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Gender | Male
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 275 SE CABOT DR SUITE B-201
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City | OAK HARBOR
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State | WA
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Zip | 98277-3715
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Country | US
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Telephone | 360-675-6404
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Fax | 360-240-1301
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Provider Business Mailing Address
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Address Line | 275 SE CABOT DR SUITE B-201
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City | OAK HARBOR
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State | WA
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Zip | 98277-3715
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Country | US
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Telephone | 360-675-6404
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Fax | 360-240-1301
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE00005773
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License Number State | WA
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