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General NPI Number Information
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NPI Number | 1902609134
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Entity Type | Individual
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Provider Name | COLBERN JOSEFCHAK D.D.S
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Gender | Male
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-327-3041
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Fax | 708-327-3489
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Provider Business Mailing Address
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Address Line | 2627 SEVERANCE ST
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City | LOS ANGELES
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State | CA
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Zip | 90007-2531
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Country | US
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Telephone | 719-354-8313
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 018.002304
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License Number State | IL
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