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General NPI Number Information
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NPI Number | 1144603242
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Entity Type | Individual
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Provider Name | JASON RENZ D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 11559 CUMBERLAND RD SUITE 100
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City | FISHERS
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State | IN
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Zip | 46037-9784
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Country | US
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Telephone | 317-579-5400
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Fax | 317-579-5410
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Provider Business Mailing Address
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Address Line | 14958 BONNER CIR
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City | FISHERS
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State | IN
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Zip | 46037-5512
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Country | US
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Telephone | 574-952-7324
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 12012356A
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License Number State | IN
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