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General NPI Number Information
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NPI Number | 1609904366
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Entity Type | Individual
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Provider Name | JERSON M. VASQUEZ D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/02/2013
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Provider Practice Location Address
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Address Line | 270 E. 7TH STREET SUITE 2B
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City | UPLAND
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State | CA
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Zip | 91786
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Country | US
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Telephone | 909-985-1211
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Fax | 909-982-8482
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Provider Business Mailing Address
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Address Line | 16423 LOS COYOTES ST
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City | FONTANA
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State | CA
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Zip | 92336-5811
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Country | US
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Telephone | 951-237-0688
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 45535
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License Number State | CA
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