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General NPI Number Information
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NPI Number | 1477090090
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Entity Type | Organization
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Legal Business Name | RM DENTAL GROUP PLAZA
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 315 NICHOLS RD STE 211
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City | KANSAS CITY
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State | MO
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Zip | 64111
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Country | US
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Telephone | 816-714-4990
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Fax |
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Provider Business Mailing Address
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Address Line | 4532 BROADWAY APT 3S
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City | KANSAS CITY
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State | MO
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Zip | 64111
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Country | US
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Telephone | 816-714-4990
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. DANIEL EUGENE ROME
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Credential | DDS
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Telephone | 816-714-4990
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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 | 2016042390
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License Number State | MO
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