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General NPI Number Information
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NPI Number | 1073571493
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Entity Type | Individual
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Provider Name | WALTER FRANCIS RONGEY DMD
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 205 KASBERG DR
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City | TEMPLE
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State | TX
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Zip | 76502-6342
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Country | US
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Telephone | 254-654-0578
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Fax |
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Provider Business Mailing Address
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Address Line | ILLIANA VA MEDICAL CENTER, DENTAL SERVICE 1900 E. MAIN STREET
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City | DANVILLE
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State | IL
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Zip | 61832
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Country | US
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Telephone | 217-554-5859
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Fax | 217-554-5863
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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 | 019-020725
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License Number State | IL
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