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General NPI Number Information
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NPI Number | 1396843520
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Entity Type | Individual
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Provider Name | RAYMOND JOSEPH SHERIDAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2400 WESTBOROUGH BLVD SUITE NUMBER 107
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-5404
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Country | US
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Telephone | 650-876-0866
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Fax | 650-876-1857
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Provider Business Mailing Address
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Address Line | 2400 WESTBOROUGH BLVD SUITE NUMBER 107
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-5404
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Country | US
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Telephone | 650-876-0866
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Fax | 650-876-1857
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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 | 22546
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License Number State | CA
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