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General NPI Number Information
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NPI Number | 1275648909
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Entity Type | Individual
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Provider Name | MICHAEL MOSTOFI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 15 MAREBLU STE 360
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3015
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Country | US
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Telephone | 949-831-5511
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Fax | 949-831-6624
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Provider Business Mailing Address
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Address Line | 27791 LA PAZ RD
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-3919
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Country | US
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Telephone | 949-831-5511
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Fax | 949-831-6624
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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 | 52647
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License Number State | CA
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