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General NPI Number Information
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NPI Number | 1689073041
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Entity Type | Individual
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Provider Name | DANIEL OH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2014
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 7500 GREEN BAY RD STE 200
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City | KENOSHA
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State | WI
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Zip | 53142-4045
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Country | US
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Telephone | 714-452-7178
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Fax |
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Provider Business Mailing Address
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Address Line | 7500 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53142-4059
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Country | US
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Telephone | 714-452-7178
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 9094724-9921
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6001145-15
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.031524
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 021.003070
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License Number State | IL
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