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General NPI Number Information
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NPI Number | 1679801930
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Entity Type | Organization
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Legal Business Name | REMODEL COSMETIC DENTISTRY
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 6221 METROPOLITAN ST SUITE 102
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City | CARLSBAD
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State | CA
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Zip | 92009-3096
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Country | US
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Telephone | 760-918-0798
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Fax | 760-929-9231
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Provider Business Mailing Address
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Address Line | 6221 METROPOLITAN ST SUITE 102
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City | CARLSBAD
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State | CA
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Zip | 92009-3096
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Country | US
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Telephone | 760-918-0798
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Fax | 760-929-9231
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GARY JOEL BRAUNSTEIN
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Credential |
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Telephone | 760-918-0798
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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 | 26345
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License Number State | CA
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