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General NPI Number Information
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NPI Number | 1255487179
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Entity Type | Individual
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Provider Name | LEONID A TOLSTUNOV DDS, DMD
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 99 W PORTAL AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94127-1303
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Country | US
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Telephone | 415-661-6006
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Fax |
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Provider Business Mailing Address
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Address Line | 54 CRESTA VISTA DR
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City | SAN FRANCISCO
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State | CA
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Zip | 94127-1633
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Country | US
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Telephone | 415-730-9140
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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 | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 40500
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License Number State | CA
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