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General NPI Number Information
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NPI Number | 1962242503
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Entity Type | Individual
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Provider Name | KAYLA ROSE NELSON D. D. S.
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Gender | Female
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 06/22/2024
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Provider Practice Location Address
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Address Line | 4000 17TH AVE S
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City | GRAND FORKS
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State | ND
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Zip | 58201-3905
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Country | US
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Telephone | 701-775-0641
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Fax | 701-746-9328
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Provider Business Mailing Address
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Address Line | 4000 17TH AVE S
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City | GRAND FORKS
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State | ND
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Zip | 58201-3905
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Country | US
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Telephone | 701-775-0641
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Fax | 701-746-9328
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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 | D15076
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License Number State | MN
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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 | 2511
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License Number State | ND
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