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General NPI Number Information
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NPI Number | 1265547897
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Entity Type | Individual
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Provider Name | JAN STARR DDS
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Gender | Female
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1435 N MICHIGAN ST SUITE 4A
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City | PLYMOUTH
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State | IN
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Zip | 46563-1100
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Country | US
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Telephone | 574-936-8588
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Fax |
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Provider Business Mailing Address
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Address Line | 16598 PRETTY LAKE RD
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City | PLYMOUTH
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State | IN
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Zip | 46563-8264
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Country | US
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Telephone | 574-936-9851
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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 | 12007753A
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License Number State | IN
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