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General NPI Number Information
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NPI Number | 1770052854
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Entity Type | Individual
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Provider Name | FERNANDA SCANDELARI MORAIS DMD
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Gender | Female
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Dates
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Enumeration Date | 11/18/2018
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 140 N VICTORY BLVD STE 101
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City | BURBANK
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State | CA
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Zip | 91502-1848
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Country | US
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Telephone | 323-773-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 906 N DOHENY DR APT 505
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-3163
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Country | US
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Telephone | 973-462-0648
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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 | 061038
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 106940
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License Number State | CA
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