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General NPI Number Information
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NPI Number | 1518246412
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Entity Type | Individual
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Provider Name | MADANA HARVEY D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/09/2011
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 3210 FILLMORE ST SUITE 2
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City | SAN FRANCISCO
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State | CA
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Zip | 94123-3403
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Country | US
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Telephone | 415-921-4132
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Fax | 415-921-2817
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Provider Business Mailing Address
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Address Line | 147 CRESCENT AVE
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City | BURLINGAME
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State | CA
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Zip | 94010-5246
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Country | US
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Telephone |
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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 | DD3551
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 64672
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License Number State | CA
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