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General NPI Number Information
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NPI Number | 1770609547
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Entity Type | Individual
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Provider Name | SHIHO TAMAI THERIOT DDS
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 10/05/2024
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Provider Practice Location Address
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Address Line | 5400 FOUNTAIN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90029-1007
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Country | US
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Telephone | 323-461-4301
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Fax |
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Provider Business Mailing Address
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Address Line | 4753 ABARGO ST
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-4518
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Country | US
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Telephone | 504-481-4170
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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 | 5666
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS62082
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License Number State | CA
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