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General NPI Number Information
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NPI Number | 1477835270
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Entity Type | Individual
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Provider Name | GREGORY WILLIAM BOCASH DMD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 18285 COLLIER AVE SUITE B
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-2786
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Country | US
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Telephone | 951-471-0034
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Fax |
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Provider Business Mailing Address
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Address Line | 50 LORI LN
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City | CAMARILLO
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State | CA
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Zip | 93010-1231
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Country | US
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Telephone | 805-573-9508
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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 | 60573
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License Number State | CA
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