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General NPI Number Information
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NPI Number | 1669893731
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Entity Type | Individual
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Provider Name | MASLY HARSONO DDS, MS, DMD
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Gender | Male
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Dates
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Enumeration Date | 12/17/2013
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 826 E FREMONT AVE SUITE D
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City | SUNNYVALE
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State | CA
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Zip | 940873651
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Country | US
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Telephone | 650-667-1369
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Fax |
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Provider Business Mailing Address
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Address Line | 550 MORELAND WAY 4512
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City | SANTA CLARA
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State | CA
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Zip | 950544123
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Country | US
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Telephone | 650-667-1369
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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 | 1223G0001X
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Taxonomy Name | General Practice
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License Number | DN1855466
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice
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License Number | DN1855466
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License Number State | MA
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