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General NPI Number Information
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NPI Number | 1114930450
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Entity Type | Individual
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Provider Name | LYNDI LEVO BACH DMD, MS
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Gender | Female
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 1920 E 17TH ST STE 120
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City | SANTA ANA
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State | CA
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Zip | 92705-8626
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Country | US
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Telephone | 949-379-1516
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Fax |
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Provider Business Mailing Address
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Address Line | 17575 CHATHAM DR
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City | TUSTIN
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State | CA
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Zip | 92780-2302
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Country | US
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Telephone | 714-348-2684
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 50007
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License Number State | CA
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