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NPI 1366654626

NPI 1366654626 : LEONA K JANDA DDS : GRAND ISLAND, NE

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General NPI Number Information
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    NPI Number           |    1366654626
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    Entity Type          |    Individual 
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    Provider Name        |    LEONA K JANDA DDS
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    05/07/2007
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    2009 WEST FAIDLEY AVE 
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    City                 |    GRAND ISLAND
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    State                |    NE
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    Zip                  |    68803-4644
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    Country              |    US
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    Telephone            |    308-382-8677
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    Fax                  |    308-382-1328
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Provider Business Mailing Address
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    Address Line         |    2009 WEST FAIDLEY AVE 
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    City                 |    GRAND ISLAND
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    State                |    NE
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    Zip                  |    68803-4644
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    Country              |    US
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    Telephone            |    308-382-8677
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    Fax                  |    308-382-1328
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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       |    5575
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    License Number State |    NE
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