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General NPI Number Information
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NPI Number | 1720827934
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Entity Type | Individual
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Provider Name | ELEANOR MARIA REVELIS DDS
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Gender | Female
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 7631 CASS ST
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City | OMAHA
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State | NE
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Zip | 68114-3623
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Country | US
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Telephone | 402-393-0594
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Fax |
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Provider Business Mailing Address
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Address Line | N9023 LAKESHORE RD
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City | SHEBOYGAN
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State | WI
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Zip | 53083-5123
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Country | US
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Telephone | 920-918-5399
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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 | 00206047
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8068
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License Number State | NE
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