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General NPI Number Information
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NPI Number | 1255031464
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Entity Type | Individual
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Provider Name | RYAN JOSEPH RODEF DMD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 07/04/2025
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Provider Practice Location Address
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Address Line | 2233 E GARVEY AVE N
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City | WEST COVINA
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State | CA
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Zip | 91791-1500
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Country | US
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Telephone | 626-966-3033
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Fax |
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Provider Business Mailing Address
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Address Line | 149 S BARRINGTON AVE # 214
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City | LOS ANGELES
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State | CA
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Zip | 90049-3310
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Country | US
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Telephone | 310-975-9953
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 111393
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 111393
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License Number State | CA
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