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General NPI Number Information
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NPI Number | 1104425131
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Entity Type | Organization
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Legal Business Name | HOSSEIN MALAKOOTI A DENTAL CORPORATION
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Dates
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Enumeration Date | 10/21/2020
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 16540 MERRILL AVE
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City | FONTANA
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State | CA
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Zip | 92335
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Country | US
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Telephone | 909-600-7126
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Fax |
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Provider Business Mailing Address
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Address Line | 6598 E FORDHAM CIR
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City | ANAHEIM
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State | CA
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Zip | 92807-5010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. HOSSEIN MALAKOOTI
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Credential | DDS
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Telephone | 909-600-7126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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