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General NPI Number Information
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NPI Number | 1003938630
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Entity Type | Organization
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Legal Business Name | MADEL P LACSON DMD INC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5211 E WASHINGTON BLVD SUITE #7
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City | COMMERCE
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State | CA
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Zip | 90040-3960
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Country | US
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Telephone | 323-267-0000
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Fax | 323-265-4442
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Provider Business Mailing Address
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Address Line | 5211 E WASHINGTON BLVD SUITE #7
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City | COMMERCE
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State | CA
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Zip | 90040-3960
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Country | US
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Telephone | 323-267-0000
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Fax | 323-265-4442
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Authorized Official
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Title or Position | PRESIDENT DENTIST
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Name | DR. MADEL P LACSON
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Credential | DMD
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Telephone | 323-267-0000
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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 | 49353
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License Number State | CA
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