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General NPI Number Information
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NPI Number | 1073451266
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Entity Type | Organization
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Legal Business Name | LEAH FAX DDS PLLC
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 3739 GRAND BLVD
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City | BROOKFIELD
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State | IL
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Zip | 60513-1623
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Country | US
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Telephone | 608-438-9468
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Fax |
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Provider Business Mailing Address
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Address Line | 735 N CATHERINE AVE
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City | LA GRANGE PARK
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State | IL
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Zip | 60526-1504
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Country | US
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Telephone | 608-438-9468
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. LEAH FAX
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Credential | DDS
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Telephone | 608-438-9468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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