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General NPI Number Information
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NPI Number | 1528270139
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Entity Type | Individual
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Provider Name | BIJAN MOGHADAM DMD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1016 BROWN ST
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City | PEEKSKILL
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State | NY
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Zip | 10566-3606
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Country | US
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Telephone | 914-737-0703
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Fax |
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Provider Business Mailing Address
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Address Line | 410 POLLY PK RD
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City | RYE
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State | NY
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Zip | 10580-1944
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Country | US
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Telephone | 914-967-1808
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 039728
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License Number State | NY
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