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General NPI Number Information
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NPI Number | 1659452357
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Entity Type | Individual
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Provider Name | MASIH SHAHLAIE B.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16944 W BELL RD SUITE B-1
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City | SURPRISE
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State | AZ
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Zip | 85374-8950
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Country | US
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Telephone | 623-214-5518
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Fax | 623-214-5572
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Provider Business Mailing Address
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Address Line | 16283 N 99TH WAY
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2239
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Country | US
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Telephone | 480-747-1969
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Fax | 480-361-3074
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D5713
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 050439
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License Number State | NY
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