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General NPI Number Information
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NPI Number | 1629639877
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Entity Type | Individual
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Provider Name | RAJVEER SINGH BAL DMD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 09/26/2021
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Provider Practice Location Address
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Address Line | 1030 W JERICHO TPKE
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City | SMITHTOWN
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State | NY
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Zip | 11787-3215
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Country | US
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Telephone | 631-486-6364
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Fax |
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Provider Business Mailing Address
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Address Line | 8008 267TH ST
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City | GLEN OAKS
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State | NY
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Zip | 11004-1528
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Country | US
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Telephone | 646-824-5992
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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 | DEN1002049
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 062073
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License Number State | NY
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