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General NPI Number Information
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NPI Number | 1568632016
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Entity Type | Individual
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Provider Name | BRIAN L GREY D.D.S., M.S.D
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Gender | Male
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 120 9TH ST
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City | LAKEPORT
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State | CA
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Zip | 95453-4320
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Country | US
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Telephone | 707-263-5390
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Fax | 707-263-9269
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Provider Business Mailing Address
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Address Line | 120 9TH ST
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City | LAKEPORT
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State | CA
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Zip | 95453-4320
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Country | US
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Telephone | 707-263-5390
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Fax | 707-263-9269
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 37557
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License Number State | CA
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