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General NPI Number Information
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NPI Number | 1255340402
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Entity Type | Organization
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Legal Business Name | HINSDALE PERIODONTICS & ENDODONTICS
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 828 N CASS AVE
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City | WESTMONT
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State | IL
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Zip | 60559-1394
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Country | US
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Telephone | 630-655-3737
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4656
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City | OAK BROOK
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State | IL
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Zip | 60522-4656
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Country | US
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Telephone | 630-655-3737
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW W BROWAR
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Credential | DDS
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Telephone | 630-655-3737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 21-001083
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 21-001141
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License Number State | IL
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