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General NPI Number Information
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NPI Number | 1497817647
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Entity Type | Individual
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Provider Name | MOHAMED IBRAHIM ABDELHAMED DDS
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 320 S CHEROKEE LN
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City | LODI
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State | CA
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Zip | 95240-4266
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Country | US
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Telephone | 209-366-7970
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Fax |
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Provider Business Mailing Address
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Address Line | 10270 E TARON DR APT 70
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City | ELK GROVE
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State | CA
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Zip | 95757-8225
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Country | US
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Telephone | 916-613-7989
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 51888
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License Number State | CA
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