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General NPI Number Information
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NPI Number | 1568026987
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Entity Type | Organization
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Legal Business Name | EDWARD T REIDY DDS PC
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 9280 MAST BLVD NONE
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City | SANTEE
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State | CA
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Zip | 92071-2150
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Country | US
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Telephone | 619-449-8530
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Fax | 619-449-8531
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Provider Business Mailing Address
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Address Line | 9280 MAST BLVD NONE
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City | SANTEE
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State | CA
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Zip | 92071-2150
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Country | US
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Telephone | 619-449-8530
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Fax | 619-449-8531
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. EDWARD T REIDY
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Credential | DDS
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Telephone | 619-449-8530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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