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General NPI Number Information
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NPI Number | 1780916411
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Entity Type | Organization
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Legal Business Name | VILAS BALAKRISHNA DMD PC
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Dates
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Enumeration Date | 02/05/2010
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 6127 SOUTH RAINBOW SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89118-3256
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Country | US
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Telephone | 702-998-2237
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Fax | 702-243-2893
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Provider Business Mailing Address
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Address Line | 6127 S RAINBOW BLVD SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89118-3255
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Country | US
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Telephone | 702-998-2237
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Fax | 702-243-2893
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Authorized Official
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Title or Position | OWNER
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Name | DR. VILAS BALAKRISHNA
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Credential | DMD
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Telephone | 702-998-2237
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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 | 5053
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License Number State | NV
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