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General NPI Number Information
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NPI Number | 1427430016
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Entity Type | Individual
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Provider Name | FARZAD MAZLOOMI DMD
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Gender | Male
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 8330 LONG BEACH BLVD STE 107
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City | SOUTH GATE
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State | CA
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Zip | 90280-2073
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Country | US
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Telephone | 847-701-1457
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Fax | 847-496-4850
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Provider Business Mailing Address
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Address Line | 8330 LONG BEACH BLVD STE 107
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City | SOUTH GATE
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State | CA
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Zip | 90280-2073
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Country | US
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Telephone | 323-582-5411
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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 | 102653
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License Number State | CA
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