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General NPI Number Information
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NPI Number | 1659640027
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Entity Type | Organization
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Legal Business Name | KYLE J. FRISINGER D.M.D. PC
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 845 SW 17TH ST STE 201
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City | REDMOND
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State | OR
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Zip | 97756-2576
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Country | US
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Telephone | 541-504-0880
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Fax | 541-504-9956
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Provider Business Mailing Address
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Address Line | 845 SW 17TH ST STE 201
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City | REDMOND
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State | OR
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Zip | 97756-2576
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Country | US
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Telephone | 541-504-0880
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Fax |
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Authorized Official
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Title or Position | OWNER/SECRETARY
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Name | MRS. MARIANNA FRISINGER
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Credential |
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Telephone | 541-504-0880
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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 | D8625
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License Number State | OR
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