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General NPI Number Information
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NPI Number | 1194691345
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Entity Type | Individual
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Provider Name | LUAY JABR
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Gender | Male
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 5328 COLDWATER RD
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City | FORT WAYNE
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State | IN
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Zip | 46825-5445
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Country | US
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Telephone | 260-471-5016
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Fax |
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Provider Business Mailing Address
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Address Line | 420 WESTFALL RD APT 20
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City | ROCHESTER
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State | NY
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Zip | 14620-4650
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Country | US
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Telephone | 619-383-4446
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12014892A
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License Number State | IN
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