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General NPI Number Information
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NPI Number | 1770676645
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Entity Type | Individual
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Provider Name | GARY KIJANKA DMD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 6979 CHIPPEWA ST
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City | SAINT LOUIS
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State | MO
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Zip | 63109-3039
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Country | US
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Telephone | 561-307-1361
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Fax |
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Provider Business Mailing Address
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Address Line | 10333 N MILITARY TRL STE B
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City | WEST PALM BEACH
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State | FL
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Zip | 33410-4601
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Country | US
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Telephone | 561-776-3116
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Fax | 561-776-3165
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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 | 2025051251
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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 | DN14241
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License Number State | FL
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