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General NPI Number Information
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NPI Number | 1316150964
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Entity Type | Organization
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Legal Business Name | MOHAMMAD ABUL FIELAT DDS INC
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 02/08/2018
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Provider Practice Location Address
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Address Line | 16946 MARYGOLD AVE STE #101
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City | FONTANA
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State | CA
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Zip | 92335
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Country | US
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Telephone | 909-355-0385
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Fax | 909-355-0585
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Provider Business Mailing Address
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Address Line | 9193 SIERRA AVE SUITE B
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City | FONTANA
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State | CA
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Zip | 92335
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Country | US
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Telephone | 909-355-0385
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Fax | 909-355-0585
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMAD G ABUL FIELAT
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Credential | PEDO
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Telephone | 909-355-0385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | CA43302
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License Number State | CA
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