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General NPI Number Information
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NPI Number | 1104002294
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Entity Type | Organization
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Legal Business Name | ORAL SURGERY OFFICE INC
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 730 SUNRISE AVE STE 130
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City | ROSEVILLE
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State | CA
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Zip | 95661
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Country | US
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Telephone | 916-782-2161
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Fax | 916-782-0677
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Provider Business Mailing Address
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Address Line | 730 SUNRISE AVE STE 130
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City | ROSEVILLE
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State | CA
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Zip | 95661
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Country | US
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Telephone | 916-782-2161
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Fax | 916-782-0677
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. REGINALD E GOWANS
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Credential | DDS
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Telephone | 916-782-2161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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