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General NPI Number Information
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NPI Number | 1548760630
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Entity Type | Individual
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Provider Name | STEPHEN DEPIRRO II LD
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Gender | Male
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Dates
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Enumeration Date | 02/15/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 740 AVENUE H STE 2
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City | SEASIDE
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State | OR
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Zip | 97138-6603
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Country | US
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Telephone | 833-909-1050
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Fax |
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Provider Business Mailing Address
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Address Line | 5791 JADEITE AVE
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City | ALTA LOMA
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State | CA
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Zip | 91737-2264
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Country | US
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Telephone | 253-370-8190
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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 | 122400000X
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Taxonomy Name | Denturist
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License Number | DN-60139787
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License Number State | WA
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