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General NPI Number Information
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NPI Number | 1518667948
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Entity Type | Individual
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Provider Name | INDU CHERANGAPADATH RADHAKRISHNAN
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Gender | Female
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 3867 UNION DEPOSIT RD
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City | HARRISBURG
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State | PA
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Zip | 17109-5920
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Country | US
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Telephone | 262-302-0954
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 CONESTOGA RD APT C259
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City | BRYN MAWR
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State | PA
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Zip | 19010-1547
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Country | US
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Telephone | 262-302-0954
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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 | DS044195
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License Number State | PA
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