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General NPI Number Information
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NPI Number | 1174169734
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Entity Type | Organization
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Legal Business Name | FARZAD MAZLOOMI DMD INC.
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 8330 LONG BEACH BLVD STE 107
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City | SOUTH GATE
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State | CA
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Zip | 90280-2073
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Country | US
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Telephone | 323-582-5411
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Fax | 323-582-5568
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Provider Business Mailing Address
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Address Line | 8330 LONG BEACH BLVD STE 107
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City | SOUTH GATE
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State | CA
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Zip | 90280-2073
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Country | US
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Telephone | 323-582-5411
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Fax | 323-582-5568
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Authorized Official
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Title or Position | OWNER
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Name | DR. FARZAD MAZLOOMI
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Credential | DMD
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Telephone | 559-250-8861
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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 |
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License Number State |
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