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General NPI Number Information
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NPI Number | 1235478256
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Entity Type | Organization
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Legal Business Name | PERRY DENTAL INC
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Dates
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Enumeration Date | 02/12/2013
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 10333 HOLE AVE
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City | RIVERSIDE
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State | CA
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Zip | 92505-1747
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Country | US
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Telephone | 951-688-7150
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Fax | 951-688-0184
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Provider Business Mailing Address
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Address Line | 10333 HOLE AVE
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City | RIVERSIDE
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State | CA
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Zip | 92505-1747
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Country | US
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Telephone | 951-688-7150
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Fax | 951-688-0184
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT BLAINE PERRY
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Credential | DDS
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Telephone | 951-688-7150
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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 | 20038
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License Number State | CA
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