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General NPI Number Information
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NPI Number | 1225489859
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Entity Type | Individual
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Provider Name | MAYANK CHALIAWALA
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Gender | Male
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Dates
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Enumeration Date | 06/24/2016
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 35 TALCOTTVILLE RD STE 21
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City | VERNON
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State | CT
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Zip | 06066-5261
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Country | US
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Telephone | 860-896-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 HARTFORD TPKE APT 593
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City | VERNON
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State | CT
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Zip | 06066-9405
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Country | US
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Telephone | 201-850-3567
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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 | 2.011651
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11651
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License Number State | CT
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