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General NPI Number Information
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NPI Number | 1871500611
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Entity Type | Individual
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Provider Name | VIJAYALAKSHMI CANAKALAVENKATA DMD
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Gender | Female
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 66 KENNEDY PLZ
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City | PROVIDENCE
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State | RI
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Zip | 02903-2004
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Country | US
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Telephone | 401-454-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 860 HARRISON AVE APT 1012
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City | BOSTON
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State | MA
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Zip | 02118-4002
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Country | US
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Telephone | 617-504-0406
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN02932
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License Number State | RI
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