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General NPI Number Information
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NPI Number | 1427132240
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Entity Type | Individual
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Provider Name | DR. JEFFREY PAUL GOEDEKER
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8190 WINDFALL LN STE B
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City | CAMBY
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State | IN
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Zip | 46113-7907
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Country | US
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Telephone | 317-821-0600
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Fax | 317-821-0606
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Provider Business Mailing Address
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Address Line | 7622 SERGI CANYON DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46217-7174
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Country | US
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Telephone | 317-859-3580
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 12010781A
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License Number State | IN
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