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General NPI Number Information
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NPI Number | 1922632694
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Entity Type | Individual
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Provider Name | STANLEY CARADINE
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Gender | Male
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 4017 E 2603RD RD
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City | SHERIDAN
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State | IL
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Zip | 60551-9502
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Country | US
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Telephone | 815-496-2181
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 277849
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City | RIVERDALE
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State | IL
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Zip | 60827-7849
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Country | US
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Telephone | 708-986-4234
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019021871
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License Number State | IL
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