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General NPI Number Information
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NPI Number | 1497195838
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Entity Type | Individual
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Provider Name | ANGELA M HASTINGS DMD
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Gender | Female
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Dates
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Enumeration Date | 06/30/2013
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Last Update Date | 08/16/2014
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Provider Practice Location Address
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Address Line | 6140 LAKE LINDEN DR SUITE 111
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City | EXCELSIOR
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State | MN
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Zip | 55331-2954
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Country | US
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Telephone | 952-380-1111
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Fax | 952-380-1111
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Provider Business Mailing Address
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Address Line | 7013 CAREY LN
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City | MAPLE GROVE
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State | MN
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Zip | 55369-5406
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Country | US
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Telephone | 763-221-5934
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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 | D13264
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License Number State | MN
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