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General NPI Number Information
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NPI Number | 1649063793
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Entity Type | Organization
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Legal Business Name | DENTSENSUS, PLLC
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 1320 W NORTHMOOR RD STE A
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City | PEORIA
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State | IL
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Zip | 61614-3425
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Country | US
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Telephone | 414-841-2881
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Fax |
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Provider Business Mailing Address
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Address Line | 810 E BROWN DEER RD
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City | MILWAUKEE
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State | WI
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Zip | 53217-1901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | JACK KALLOCH
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Credential | DMD
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Telephone | 414-841-2881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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