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General NPI Number Information
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NPI Number | 1679873186
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Entity Type | Organization
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Legal Business Name | EDMUND W. JAY, D.D.S.,INC.
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Dates
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Enumeration Date | 10/31/2010
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Last Update Date | 10/31/2010
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Provider Practice Location Address
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Address Line | 3737 MORAGA AVE B-300
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City | SAN DIEGO
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State | CA
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Zip | 92117-5404
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Country | US
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Telephone | 858-270-0682
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Fax | 858-270-0685
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Provider Business Mailing Address
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Address Line | 3737 MORAGA AVE B-300
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City | SAN DIEGO
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State | CA
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Zip | 92117-5404
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Country | US
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Telephone | 858-270-0682
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Fax | 858-270-0685
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Authorized Official
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Title or Position | PRESIDENT / OWNER DENTIST
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Name | DR. EDMUND WALT JAY
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Credential | D.D.S.
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Telephone | 858-270-0682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 36384
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License Number State | CA
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