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General NPI Number Information
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NPI Number | 1063849180
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Entity Type | Individual
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Provider Name | OLIVER SILVESTRE CRUZ D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 02/12/2019
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Provider Practice Location Address
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Address Line | 5825 LINCOLN AVE STE H
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City | BUENA PARK
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State | CA
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Zip | 90620-3477
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Country | US
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Telephone | 310-594-4902
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Fax | 714-761-7179
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Provider Business Mailing Address
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Address Line | 212 W 219TH ST
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City | CARSON
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State | CA
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Zip | 90745-2922
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Country | US
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Telephone | 310-594-4902
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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 | 62551
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License Number State | CA
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