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General NPI Number Information
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NPI Number | 1508341694
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Entity Type | Individual
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Provider Name | TOMMIE JANAE KELL EPDH
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Gender | Female
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 235 W MAIN ST FL 2
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City | JACKSONVILLE
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State | OR
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Zip | 97530-9278
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Country | US
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Telephone | 541-817-6453
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 816
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City | JACKSONVILLE
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State | OR
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Zip | 97530-0816
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Country | US
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Telephone | 541-817-6453
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H6066
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License Number State | OR
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