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General NPI Number Information
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NPI Number | 1992694822
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Entity Type | Individual
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Provider Name | JARED M ELLINGSON DMD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 787 N MAIN ST
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City | OREGON
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State | WI
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Zip | 53575-1030
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Country | US
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Telephone | 618-819-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 COUNTY ROAD MN
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City | COTTAGE GROVE
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State | WI
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Zip | 53527-9514
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Country | US
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Telephone | 815-262-5332
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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 | 6001882-15
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License Number State | WI
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