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General NPI Number Information
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NPI Number | 1922216852
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Entity Type | Individual
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Provider Name | LOUIS WILLIAM KONSTAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11 S CLEVELAND AVE
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City | MOGADORE
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State | OH
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Zip | 44260-1514
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Country | US
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Telephone | 330-628-3017
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Fax |
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Provider Business Mailing Address
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Address Line | 2509 WORTHINGTON RD
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City | AKRON
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State | OH
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Zip | 44313-4223
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Country | US
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Telephone | 330-338-2022
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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 | 30.018523
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License Number State | OH
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