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General NPI Number Information
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NPI Number | 1760794176
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Entity Type | Organization
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Legal Business Name | DENTAL WISH LTD
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 4101 W 26TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-4313
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Country | US
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Telephone | 773-277-8834
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Fax | 773-277-8873
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Provider Business Mailing Address
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Address Line | 414 WOODSIDE DR
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City | WOOD DALE
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State | IL
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Zip | 60191-2535
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Country | US
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Telephone | 773-277-8834
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Fax | 773-277-8873
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUNITA SAHU
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Credential | DDS
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Telephone | 630-660-8929
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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 | 019027006
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License Number State | IL
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