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General NPI Number Information
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NPI Number | 1184888398
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Entity Type | Organization
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Legal Business Name | AL MANESH DMD INC
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 24953 PASEO DE VALENCIA STE 13C
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-4344
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Country | US
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Telephone | 949-600-7123
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Fax | 949-364-2870
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Provider Business Mailing Address
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Address Line | 26800 CROWN VALLEY PKWY SUITE 425
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6384
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Country | US
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Telephone | 949-364-2935
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Fax | 949-364-2870
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Authorized Official
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Title or Position | OWNER
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Name | DR. AL SHYSTE MANESH
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Credential | D.M.D.
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Telephone | 949-364-2935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 48376
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 48376
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License Number State | CA
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