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General NPI Number Information
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NPI Number | 1063929503
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Entity Type | Individual
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Provider Name | JO ANN MCCAULEY
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Gender | Female
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 01/05/2018
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Provider Practice Location Address
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Address Line | 114 W FOX ST
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City | CARLSBAD
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State | NM
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Zip | 88220-6212
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Country | US
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Telephone | 575-236-1001
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3087
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City | CARLSBAD
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State | NM
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Zip | 88221-3087
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Country | US
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Telephone | 575-236-1001
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Fax |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH1521
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License Number State | NM
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