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General NPI Number Information
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NPI Number | 1508428954
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Entity Type | Organization
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Legal Business Name | DANIEL J. DECILLIS, DDS, LLC
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Dates
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Enumeration Date | 07/06/2019
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Last Update Date | 07/06/2019
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Provider Practice Location Address
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Address Line | 1144 IOWA ST STE A
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City | ASHLAND
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State | OR
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Zip | 97520-2385
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Country | US
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Telephone | 541-482-4995
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Fax |
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Provider Business Mailing Address
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Address Line | 1144 IOWA ST STE A
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City | ASHLAND
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State | OR
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Zip | 97520-2385
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DANIEL DECILLIS
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Credential | DDS
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Telephone | 704-557-6101
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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 |
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License Number State |
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