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General NPI Number Information
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NPI Number | 1497915854
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Entity Type | Organization
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Legal Business Name | VAIL ORAL AND MAXILLOFACIAL RADIOLOGY, LLC
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 105 EDWARDS VILLAGE BLVD # C-205
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City | EDWARDS
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State | CO
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Zip | 81632-9914
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Country | US
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Telephone | 970-569-3055
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Fax | 970-569-3057
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Provider Business Mailing Address
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Address Line | PO BOX 4507 0105 EDWARDS VILLAGE BLVD #C-205
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City | EDWARDS
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State | CO
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Zip | 81632-4507
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Country | US
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Telephone | 970-569-3055
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Fax | 970-569-3057
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JAMES GAREL
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Credential | D.D.S.
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Telephone | 970-569-3055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 104546
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License Number State | CO
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