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General NPI Number Information
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NPI Number | 1376621599
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Entity Type | Individual
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Provider Name | DEVILA J. SHAH D.D.S. FAGD
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1279 E VISTA WAY
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City | VISTA
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State | CA
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Zip | 92084-4039
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Country | US
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Telephone | 516-931-3615
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Fax | 516-931-3616
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Provider Business Mailing Address
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Address Line | 11624 CANDY ROSE WAY
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City | SANDIEGO
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State | CA
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Zip | 92131
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Country | US
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Telephone | 858-564-9400
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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 | 38937-1
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License Number State | NY
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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 | DDS62414
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License Number State | CA
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