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General NPI Number Information
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NPI Number | 1942474879
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Entity Type | Organization
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Legal Business Name | RAVI BALU DMD PC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 210 LAUREL DR
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City | CONNELLSVILLE
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State | PA
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Zip | 15425-3869
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Country | US
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Telephone | 724-628-9340
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Fax | 724-628-4090
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Provider Business Mailing Address
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Address Line | 210 LAUREL DR
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City | CONNELLSVILLE
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State | PA
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Zip | 15425-3869
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Country | US
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Telephone | 724-628-9340
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Fax | 724-628-4090
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CAROL FOSTER
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Credential |
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Telephone | 724-628-9340
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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 | DS015819L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS037382
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS031148L
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS027029L
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License Number State | PA
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