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General NPI Number Information
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NPI Number | 1558594580
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Entity Type | Individual
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Provider Name | PAULA SUSAN FILLAK D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 08/25/2014
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Provider Practice Location Address
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Address Line | 25214 W REED ST
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City | CHANNAHON
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State | IL
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Zip | 60410
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Country | US
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Telephone | 815-922-7342
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Fax |
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Provider Business Mailing Address
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Address Line | 10805 OAKTON CT
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City | FRANKFORT
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State | IL
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Zip | 60423-8541
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Country | US
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Telephone | 815-922-7342
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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 | 019023056
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License Number State | IL
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