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General NPI Number Information
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NPI Number | 1548798721
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Entity Type | Individual
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Provider Name | KISHAN VINOD PATEL DMD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 05/31/2017
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Provider Practice Location Address
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Address Line | 55 SACK BLVD
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City | LEOMINSTER
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State | MA
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Zip | 01453-3325
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Country | US
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Telephone | 978-466-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 350 N CLARK ST STE 600 C/O KOS SERVICES, ATTN: HR
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City | CHICAGO
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State | IL
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Zip | 60654
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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 |
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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 | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | DN1857592
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License Number State | MA
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