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General NPI Number Information
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NPI Number | 1639377955
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Entity Type | Individual
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Provider Name | MITCHELL JARED WILLIAMS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2007
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 9085 E MINERAL CIR STE 220
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City | CENTENNIAL
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State | CO
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Zip | 80112-3400
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Country | US
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Telephone | 303-798-1068
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Fax | 303-798-1538
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Provider Business Mailing Address
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Address Line | 7129 E PEAKIVEW PLACE
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City | CENTENNIAL
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State | CO
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Zip | 80111-4621
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Country | US
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Telephone | 303-221-0059
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D12459
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN-9483
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License Number State | CO
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