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General NPI Number Information
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NPI Number | 1134517139
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Entity Type | Organization
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Legal Business Name | EMINE C. LOXLEY DMD, PC
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 3536 MENDOCINO AVE SUITE 330
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City | SANTA ROSA
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State | CA
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Zip | 95403-3634
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Country | US
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Telephone | 707-545-4104
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Fax | 707-545-9668
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Provider Business Mailing Address
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Address Line | 3536 MENDOCINO AVE SUITE 330
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City | SANTA ROSA
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State | CA
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Zip | 95403-3634
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Country | US
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Telephone | 707-545-4104
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Fax | 707-545-9668
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Authorized Official
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Title or Position | OWNER
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Name | DR. EMINE C LOXLEY
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Credential | DMD
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Telephone | 707-545-4104
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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 | 57813
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License Number State | CA
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