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General NPI Number Information
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NPI Number | 1356305924
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Entity Type | Individual
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Provider Name | KEITH L VALACHI
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Gender | Male
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 9900 SW WILSHIRE ST. SUITE 120
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City | PORTLAND
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State | OR
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Zip | 97225
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Country | US
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Telephone | 971-271-7478
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Fax | 503-296-2967
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Provider Business Mailing Address
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Address Line | 9900 SW WILSHIRE ST. SUITE 120
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City | PORTLAND
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State | OR
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Zip | 97225
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Country | US
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Telephone | 971-271-7478
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Fax | 503-296-2967
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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 | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | D6487
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D6487
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License Number State | OR
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