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General NPI Number Information
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NPI Number | 1548309743
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Entity Type | Individual
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Provider Name | ANDY KOULTOURIDES DDS
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 619 RIDGE ROAD
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City | MUNSTER
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State | IN
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Zip | 46321
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Country | US
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Telephone | 219-836-1111
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Fax | 219-836-1410
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Provider Business Mailing Address
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Address Line | 619 RIDGE ROAD
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City | MUNSTER
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State | IN
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Zip | 46321
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Country | US
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Telephone | 219-836-1111
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Fax | 219-836-1410
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 12009245
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License Number State | IN
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