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General NPI Number Information
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NPI Number | 1891890463
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Entity Type | Individual
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Provider Name | DAMON JENKINS DMD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 483 WEST MIDDLE TURNPIKE
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City | MANCHESTER
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State | CT
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Zip | 06040
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Country | US
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Telephone | 860-645-0111
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Fax | 860-533-9027
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Provider Business Mailing Address
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Address Line | 39 BUCKLAND STREET UNIT 1033-4
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City | MANCHESTER
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State | CT
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Zip | 06040
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Country | US
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Telephone | 504-400-0682
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Fax | 860-533-9027
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 009646
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License Number State | CT
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