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General NPI Number Information
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NPI Number | 1376244871
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Entity Type | Organization
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Legal Business Name | CHANDIRAMANI ORTHO PLLC
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 10639 MEETING ST UNIT 101
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City | PROSPECT
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State | KY
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Zip | 40059-6503
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Country | US
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Telephone | 502-396-2439
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Fax |
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Provider Business Mailing Address
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Address Line | 11838 LAKESTONE WAY
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City | PROSPECT
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State | KY
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Zip | 40059-9000
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Country | US
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Telephone | 502-396-2439
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST/MANAGER
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Name | DR. RAINA CHANDIRAMANI
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Credential | DMD, MS
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Telephone | 502-396-2439
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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 |
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License Number State |
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