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General NPI Number Information
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NPI Number | 1518687888
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Entity Type | Organization
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Legal Business Name | GARDEN GROVE MEDICAL AND DENTAL SURGERY CENTER, LLC
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Dates
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Enumeration Date | 08/29/2022
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 12828 HARBOR BLVD STE 210
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City | GARDEN GROVE
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State | CA
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Zip | 92840-5834
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Country | US
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Telephone | 714-844-9212
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Fax | 714-844-9212
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Provider Business Mailing Address
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Address Line | 12828 HARBOR BLVD STE 210
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City | GARDEN GROVE
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State | CA
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Zip | 92840-5834
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Country | US
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Telephone | 714-844-9212
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Fax | 714-844-9212
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | DR. MOHAMMAD ABDUL-FIELAT
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Credential | DDS
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Telephone | 951-818-6017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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