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General NPI Number Information
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NPI Number | 1316323488
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Entity Type | Individual
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Provider Name | SARAH A WOLOSZCZUK
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Gender | Female
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 1601 N HARLEM AVE
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City | CHICAGO
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State | IL
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Zip | 60707-4303
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Country | US
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Telephone | 773-745-3301
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Fax |
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Provider Business Mailing Address
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Address Line | 5806 SHERMAN AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-1166
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Country | US
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Telephone | 630-297-5874
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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 | 020015153
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License Number State | IL
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