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General NPI Number Information
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NPI Number | 1366697070
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Entity Type | Organization
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Legal Business Name | BRUCE B. WILAND, DDS, MSD
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 3415 S LAFOUNTAIN ST STE K
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City | KOKOMO
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State | IN
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Zip | 46902-3827
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Country | US
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Telephone | 765-864-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 3415 S LAFOUNTAIN ST STE K
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City | KOKOMO
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State | IN
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Zip | 46902-3827
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Country | US
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Telephone | 765-864-0700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE WILAND
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Credential | DDS, MSD
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Telephone | 765-864-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 12008945
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License Number State | IN
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