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General NPI Number Information
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NPI Number | 1679695118
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Entity Type | Individual
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Provider Name | JOEL GARY LUEDEKE D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 720 OLIVE ST SUITE 1700
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City | SAINT LOUIS
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State | MO
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Zip | 63101-2338
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Country | US
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Telephone | 925-487-4421
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Fax | 314-241-3204
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Provider Business Mailing Address
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Address Line | PO BOX 771460
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City | SAINT LOUIS
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State | MO
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Zip | 63177-2460
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Country | US
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Telephone | 925-899-0794
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Fax | 314-241-3204
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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 | 2008014527
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License Number State | MO
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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 | 33623
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License Number State | CA
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