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General NPI Number Information
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NPI Number | 1528166253
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Entity Type | Individual
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Provider Name | AVA LAUREN HOOD-OLSON D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 741 W STATE ST SUITE 2
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City | O FALLON
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State | IL
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Zip | 62269-1971
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Country | US
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Telephone | 618-624-0800
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Fax | 618-624-0053
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Provider Business Mailing Address
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Address Line | 146 HODGENS MILL LN
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City | O FALLON
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State | IL
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Zip | 62269-6623
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Country | US
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Telephone | 618-589-3402
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019.027173
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License Number State | IL
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