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General NPI Number Information
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NPI Number | 1417682683
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Entity Type | Individual
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Provider Name | CALEB KILLER DDS
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Gender | Male
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 530 SPRING ST
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City | FRIDAY HARBOR
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State | WA
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Zip | 98250-8057
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Country | US
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Telephone | 360-378-4944
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Fax |
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Provider Business Mailing Address
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Address Line | 701 COTTONWOOD CIR
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City | ALAMOSA
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State | CO
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Zip | 81101-8304
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Country | US
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Telephone | 210-835-5891
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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 | 61325912
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License Number State | WA
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