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General NPI Number Information
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NPI Number | 1164649034
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Entity Type | Organization
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Legal Business Name | CAMPUS FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 1825 UNIVERSITY AVE
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City | RIVERSIDE
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State | CA
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Zip | 92507-5345
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Country | US
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Telephone | 951-781-7878
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Fax | 951-781-8654
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Provider Business Mailing Address
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Address Line | PO BOX 55815
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City | RIVERSIDE
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State | CA
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Zip | 92517-0815
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Country | US
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Telephone | 951-781-7878
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Fax | 951-781-8654
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | VERONICA M FRANCO
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Credential |
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Telephone | 951-781-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 38687
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License Number State | CA
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