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General NPI Number Information
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NPI Number | 1801800420
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Entity Type | Individual
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Provider Name | TIM ELDEN POLING DDS
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 200 W WASHINGTON
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City | SAINT FRANCIS
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State | KS
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Zip | 67756-0867
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Country | US
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Telephone | 785-332-3103
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Fax | 785-332-2289
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Provider Business Mailing Address
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Address Line | PO BOX 867 200 W WASHINGTON
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City | SAINT FRANCIS
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State | KS
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Zip | 67756-0867
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Country | US
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Telephone | 785-332-3103
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Fax | 785-332-2289
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4553
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License Number State | KS
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