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General NPI Number Information
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NPI Number | 1265776090
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Entity Type | Organization
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Legal Business Name | ASAL SHIRAZI DMD, INC.
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 170 N RAYMOND AVE
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City | FULLERTON
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State | CA
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Zip | 92831-4610
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Country | US
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Telephone | 714-870-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 170 N RAYMOND AVE
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City | FULLERTON
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State | CA
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Zip | 92831-4610
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Country | US
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Telephone | 714-870-2000
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. ASAL SAHAR KOHANDEL-SHIRAZI
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Credential | D.M.D.
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Telephone | 714-870-2000
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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 | 56123
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License Number State | CA
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