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General NPI Number Information
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NPI Number | 1558786145
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Entity Type | Organization
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Legal Business Name | ABEDI ADVANCED FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 803 39TH AVE SW STE E
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City | PUYALLUP
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State | WA
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Zip | 98373-3692
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Country | US
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Telephone | 253-445-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 2318 SUNNYSIDE HEIGHTS DR
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City | STEILACOOM
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State | WA
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Zip | 98388-1365
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Country | US
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Telephone | 253-576-2411
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | PARVIN ABEDI
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Credential | OWNER
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Telephone | 253-576-2411
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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 | DE00009718
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License Number State | WA
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