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General NPI Number Information
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NPI Number | 1427129790
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Entity Type | Individual
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Provider Name | BETH E. KAILES DMD
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Gender | Female
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1998 RIVERGATE DR
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City | ORANGE PARK
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State | FL
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Zip | 32003-8686
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Country | US
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Telephone | 904-541-1444
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Fax | 904-541-1444
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Provider Business Mailing Address
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Address Line | 2245 PLANTATION CENTER DR SUITE 36
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City | ORANGE PARK
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State | FL
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Zip | 32003-3352
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Country | US
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Telephone | 904-215-7800
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Fax | 904-215-7887
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 16753
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License Number State | FL
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