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General NPI Number Information
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NPI Number | 1598967440
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Entity Type | Individual
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Provider Name | KENNETH PAUL DOALTOWSKI DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2105 W GENESEE ST SUITE 207
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City | SYRACUSE
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State | NY
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Zip | 13219-1656
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Country | US
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Telephone | 315-468-0031
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Fax | 315-487-3599
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Provider Business Mailing Address
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Address Line | 509 EMANN DR
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City | CAMILLUS
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State | NY
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Zip | 13031-3011
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Country | US
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Telephone | 315-487-1270
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Fax | 315-487-3599
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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 | 032859-1
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License Number State | NY
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