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General NPI Number Information
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NPI Number | 1508550690
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Entity Type | Individual
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Provider Name | HALAH MOHAMMED
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Gender | Female
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Dates
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Enumeration Date | 06/02/2023
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 676 N MICHIGAN AVE STE 3500
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City | CHICAGO
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State | IL
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Zip | 60611-2839
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Country | US
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Telephone | 718-630-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 610 DEL SOL DR APT 716
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City | SAN DIEGO
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State | CA
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Zip | 92108-3024
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Country | US
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Telephone | 858-257-8095
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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 | 1508550690
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License Number State | IL
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