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General NPI Number Information
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NPI Number | 1013308170
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Entity Type | Organization
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Legal Business Name | ENDO CARE
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 485 34TH ST SUITE 200
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City | OAKLAND
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State | CA
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Zip | 94609-2823
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Country | US
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Telephone | 510-547-7668
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Fax | 510-547-7665
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Provider Business Mailing Address
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Address Line | 485 34TH ST SUITE 200
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City | OAKLAND
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State | CA
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Zip | 94609-2823
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Country | US
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Telephone | 510-547-7668
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Fax | 510-547-7665
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. ALI REZAI
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Credential | DDS
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Telephone | 510-547-7668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 5035
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License Number State | CA
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