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General NPI Number Information
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NPI Number | 1639434665
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Entity Type | Individual
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Provider Name | EDIOUS K. ELLIOT DMD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 8240 CAZENOVIA RD STE 60
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City | MANLIUS
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State | NY
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Zip | 13104-8814
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Country | US
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Telephone | 315-692-6546
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Fax | 315-692-0449
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Provider Business Mailing Address
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Address Line | 8240 CAZENOVIA RD STE 60
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City | MANLIUS
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State | NY
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Zip | 13104-8814
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Country | US
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Telephone | 315-692-6546
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Fax | 315-692-0449
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 22DI02507400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | DA031767
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS040658
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License Number State | PA
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