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General NPI Number Information
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NPI Number | 1366096208
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Entity Type | Individual
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Provider Name | HAILEE RASK DDS
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Gender | Female
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 1555 E STRATFORD AVE STE 400
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-3692
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Country | US
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Telephone | 385-500-7082
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Fax |
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Provider Business Mailing Address
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Address Line | 1960 E CLAYBOURNE AVE
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-4032
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Country | US
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Telephone | 985-507-3055
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 11344038-9921
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DEN.00205781
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License Number State | CO
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