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General NPI Number Information
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NPI Number | 1487953949
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Entity Type | Individual
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Provider Name | MARIA VIRGINIA BRAVO-ESPINOZA D.D.S
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Gender | Female
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Dates
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Enumeration Date | 03/23/2011
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 16147 FOOTHILL BLVD A
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City | FONTANA
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State | CA
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Zip | 92335-0000
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Country | US
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Telephone | 909-251-4721
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Fax | 909-202-4967
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Provider Business Mailing Address
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Address Line | 8200 HAVEN AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-6958
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Country | US
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Telephone | 909-240-3888
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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 | 60187
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License Number State | CA
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