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General NPI Number Information
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NPI Number | 1336379056
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Entity Type | Individual
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Provider Name | JULIAN JEROME WILSON DDS, FACS
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Gender | Male
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 1025 W AVENUE K
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City | LANCASTER
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State | CA
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Zip | 93534-6428
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Country | US
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Telephone | 661-723-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 W SUNSET BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90029-2242
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Country | US
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Telephone | 925-219-6019
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 58886
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License Number State | CA
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