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General NPI Number Information
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NPI Number | 1629450598
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Entity Type | Organization
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Legal Business Name | LOURDES B. CAPULONG DDS INC
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 4409 EAGLE ROCK BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90041-3212
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Country | US
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Telephone | 323-257-7582
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Fax | 323-257-2612
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Provider Business Mailing Address
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Address Line | 4409 EAGLE ROCK BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90041-3212
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Country | US
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Telephone | 323-257-7582
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Fax | 323-257-2612
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LOURDES BUENO CAPULONG
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Credential | DDS
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Telephone | 323-257-7582
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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 | 40551
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License Number State | CA
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