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General NPI Number Information
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NPI Number | 1407082001
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Entity Type | Individual
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Provider Name | PETER ANDREW DRAHOS DDS
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Gender | Male
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 06/09/2009
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Provider Practice Location Address
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Address Line | 6800 W ARCHER AVE
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City | CHICAGO
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State | IL
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Zip | 60638-2312
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Country | US
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Telephone | 312-788-1001
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Fax |
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Provider Business Mailing Address
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Address Line | 10 COVE CT
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City | BURR RIDGE
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State | IL
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Zip | 60527-8369
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Country | US
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Telephone | 630-337-9986
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019027907
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License Number State | IL
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