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General NPI Number Information
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NPI Number | 1780890699
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Entity Type | Individual
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Provider Name | OLGA PATRICIA MAYA D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13549 ROSCOE BLVD
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City | PANORAMA CITY
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State | CA
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Zip | 91402-5500
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Country | US
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Telephone | 818-782-5501
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Fax | 818-782-5868
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Provider Business Mailing Address
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Address Line | 6248 WOODMAN AVE APT. #07
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City | VAN NUYS
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State | CA
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Zip | 91401-2959
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Country | US
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Telephone | 818-903-7825
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Fax | 818-782-5868
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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 | 55676
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License Number State | CA
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