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General NPI Number Information
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NPI Number | 1265957179
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Entity Type | Individual
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Provider Name | SAMANTHA MOHAN DDS
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Gender | Female
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Dates
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Enumeration Date | 08/11/2017
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 2290 BIRCH ST STE C
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City | PALO ALTO
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State | CA
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Zip | 94306-1559
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Country | US
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Telephone | 650-323-4222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3189
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City | SYRACUSE
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State | NY
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Zip | 13220-3189
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Country | US
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Telephone |
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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 | DS041499
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS102481
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License Number State | CA
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