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General NPI Number Information
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NPI Number | 1093489627
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Entity Type | Individual
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Provider Name | IAN JOSEPH OFFORD
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Gender | Male
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Dates
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Enumeration Date | 08/06/2021
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Last Update Date | 08/06/2021
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Provider Practice Location Address
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Address Line | 313 RIVER OAKS DR
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City | CALUMET CITY
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State | IL
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Zip | 60409-5816
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Country | US
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Telephone | 708-862-2328
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Fax |
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Provider Business Mailing Address
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Address Line | 1338 S MICHIGAN AVE UNIT 508
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City | CHICAGO
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State | IL
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Zip | 60605-2602
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019033102
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License Number State | IL
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