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General NPI Number Information
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NPI Number | 1881551190
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Entity Type | Individual
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Provider Name | KODI BLAIR VAUGHAN
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Gender | Female
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 5017 SOUTHVIEW DR
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City | KLAMATH FALLS
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State | OR
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Zip | 97603-8545
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Country | US
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Telephone | 541-903-9079
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 996
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City | DORRIS
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State | CA
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Zip | 96023-0996
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Country | US
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Telephone |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H8994
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License Number State | OR
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