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General NPI Number Information
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NPI Number | 1164564316
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Entity Type | Organization
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Legal Business Name | ROBERT E. BLEW
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 604 35TH AVE
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City | MOLINE
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State | IL
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Zip | 61265-6174
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Country | US
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Telephone | 309-797-4336
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Fax |
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Provider Business Mailing Address
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Address Line | 604 35TH AVE
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City | MOLINE
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State | IL
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Zip | 61265-6174
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Country | US
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Telephone | 309-797-4336
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ROBERT E BLEW
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Credential | DDS
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Telephone | 309-797-4336
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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 | 19A14799
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License Number State | IL
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