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General NPI Number Information
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NPI Number | 1245870526
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Entity Type | Individual
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Provider Name | OUIDA SEARAY VAILLANCOURT RDH
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Gender | Female
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 01/14/2020
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Provider Practice Location Address
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Address Line | 339 MONGOMERY AVE
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City | HONOLULU
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State | HI
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Zip | 96819
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Country | US
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Telephone | 808-438-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 92-100 WAIPAHE PL SLIP B-10
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City | KAPOLEI
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State | HI
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Zip | 96707-4293
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Country | US
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Telephone | 585-678-5248
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 020870-1
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License Number State | NY
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