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General NPI Number Information
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NPI Number | 1740380716
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Entity Type | Individual
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Provider Name | THOMAS R SUMNICHT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11 NAPLES ST
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City | CHULA VISTA
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State | CA
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Zip | 91911-2205
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Country | US
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Telephone | 619-426-5640
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Fax | 619-426-1763
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Provider Business Mailing Address
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Address Line | 3875 ALTA LOMA CT
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City | JAMUL
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State | CA
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Zip | 91935-1704
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Country | US
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Telephone | 619-444-5816
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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 Dentistry
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License Number | 34228
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License Number State | CA
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