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General NPI Number Information
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NPI Number | 1497131262
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Entity Type | Organization
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Legal Business Name | MARTIN LEE SCHELLINCK DDS
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 1855 SAN MIGUEL DR SUITE 14
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City | WALNUT CREEK
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State | CA
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Zip | 94596-5279
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Country | US
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Telephone | 925-300-3619
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Fax |
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Provider Business Mailing Address
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Address Line | 1855 SAN MIGUEL DR SUITE 14
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City | WALNUT CREEK
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State | CA
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Zip | 94596-5279
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Country | US
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Telephone | 925-300-3619
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. MARTIN LEE SCHELLINCK
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Credential | DDS
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Telephone | 925-300-3619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 62193
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License Number State | CA
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