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General NPI Number Information
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NPI Number | 1225481567
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Entity Type | Individual
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Provider Name | ANTHONY MINHDUC HUY PHAN DMD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 5060 SUNRISE BLVD STE A1
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City | FAIR OAKS
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State | CA
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Zip | 95628-4944
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Country | US
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Telephone | 916-622-5681
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Fax |
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Provider Business Mailing Address
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Address Line | 5041 CHICO DR
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City | ROSEVILLE
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State | CA
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Zip | 95747-4277
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Country | US
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Telephone | 916-622-5681
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 102834
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License Number State | CA
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