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General NPI Number Information
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NPI Number | 1336818533
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Entity Type | Individual
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Provider Name | JACOB E STIMMEL
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Gender | Male
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Dates
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Enumeration Date | 09/10/2021
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Last Update Date | 09/10/2021
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Provider Practice Location Address
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Address Line | 2817 REED RD
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City | BLOOMINGTON
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State | IL
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Zip | 61704-8294
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Country | US
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Telephone | 309-662-5921
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Fax |
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Provider Business Mailing Address
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Address Line | 2003 ROBERT DR
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City | CHAMPAIGN
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State | IL
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Zip | 61821-6023
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Country | US
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Telephone | 217-840-7042
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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 | 019.33337
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License Number State | IL
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