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General NPI Number Information
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NPI Number | 1639677438
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Entity Type | Organization
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Legal Business Name | CLAUDIA E VIDES INC A DENTAL CORPORATION
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 01/26/2018
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Provider Practice Location Address
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Address Line | 2033 W. 7TH STREET
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City | LOS ANGELES
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State | CA
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Zip | 90057
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Country | US
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Telephone | 562-508-8864
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Fax |
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Provider Business Mailing Address
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Address Line | 2033 W 7TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90057-4073
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Country | US
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Telephone | 562-676-6905
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Fax |
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Authorized Official
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Title or Position | OFFICE STAFF
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Name | VIOLETA GONZALEZ
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Credential |
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Telephone | 562-508-8864
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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 | 56246
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License Number State | CA
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