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General NPI Number Information
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NPI Number | 1568663805
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Entity Type | Individual
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Provider Name | ANDREA SUE CONRAD DMD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | 960 S HEBRON AVE
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City | EVANSVILLE
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State | IN
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Zip | 47714-4081
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Country | US
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Telephone | 812-473-1900
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Fax | 812-471-1487
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Provider Business Mailing Address
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Address Line | 800 1ST AVE
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City | EVANSVILLE
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State | IN
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Zip | 47710-1938
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Country | US
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Telephone | 812-425-4206
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Fax | 812-423-4466
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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 | 12011098
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License Number State | IN
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