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General NPI Number Information
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NPI Number | 1629104278
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Entity Type | Individual
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Provider Name | VIDYA MADHURI KOPPINEEDI D.D.S
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7836 NE SANDY BLVD
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City | PORTLAND
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State | OR
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Zip | 97213-6467
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Country | US
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Telephone | 503-288-3107
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Fax |
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Provider Business Mailing Address
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Address Line | 7844 SW ALDER ST
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City | TIGARD
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State | OR
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Zip | 97224-7240
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Country | US
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Telephone | 503-432-0919
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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 | D8689
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License Number State | OR
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