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General NPI Number Information
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NPI Number | 1942654363
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Entity Type | Individual
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Provider Name | AKLILU AMEHA
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Gender | Male
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 8490 E NATIONAL RD
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City | SOUTH VIENNA
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State | OH
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Zip | 45369-9707
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Country | US
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Telephone | 937-568-3302
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Fax |
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Provider Business Mailing Address
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Address Line | 4656 RALSTON ST
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City | COLUMBUS
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State | OH
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Zip | 43214-1938
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Country | US
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Telephone | 614-668-5869
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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 | 30.024972
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License Number State | OH
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