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General NPI Number Information
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NPI Number | 1184864027
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Entity Type | Individual
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Provider Name | MICHAEL DOUGLAS STAFFORD D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 111 1ST AVE
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City | ZILLAH
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State | WA
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Zip | 98953-9779
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Country | US
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Telephone | 509-829-6611
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Fax | 509-829-6663
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Provider Business Mailing Address
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Address Line | PO BOX 537
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City | ZILLAH
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State | WA
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Zip | 98953-0537
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Country | US
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Telephone | 509-895-4066
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Fax | 509-829-6663
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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 | 0102
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License Number State | MP
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60338396
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D8320
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License Number State | OR
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