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General NPI Number Information
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NPI Number | 1639467616
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Entity Type | Individual
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Provider Name | MEGAN B LY DMD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 1013 S GLENDORA AVE
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City | WEST COVINA
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State | CA
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Zip | 91790-4921
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Country | US
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Telephone | 626-960-6993
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 E LINCOLN AVE APT 260
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City | ANAHEIM
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State | CA
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Zip | 92806-4258
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Country | US
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Telephone | 609-665-9406
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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 | DDS61784
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License Number State | CA
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