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General NPI Number Information
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NPI Number | 1760097489
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Entity Type | Individual
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Provider Name | POOJA DEEPAKBHAI MEHTA DDS
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Gender | Female
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 2503 BELL RD
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City | AUBURN
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State | CA
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Zip | 95603-2533
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Country | US
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Telephone | 503-823-3803
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Fax |
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Provider Business Mailing Address
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Address Line | 39430 CIVIC CENTER DR APT 511
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City | FREMONT
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State | CA
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Zip | 94538-6706
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Country | US
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Telephone | 682-706-8002
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 105440
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License Number State | CA
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