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General NPI Number Information
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NPI Number | 1699100313
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Entity Type | Organization
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Legal Business Name | TOOTHSCALER DENTAL
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Dates
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Enumeration Date | 09/12/2013
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 2090 N CAPITOL AVE STE D
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City | SAN JOSE
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State | CA
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Zip | 95132-1017
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Country | US
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Telephone | 408-262-6301
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Fax |
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Provider Business Mailing Address
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Address Line | 1036 SUMMERMIST CT
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City | SAN JOSE
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State | CA
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Zip | 95122-3361
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Country | US
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Telephone | 408-597-2984
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KEVIN VU
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Credential | D.M.D
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Telephone | 408-262-6301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 44798
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License Number State | CA
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