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General NPI Number Information
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NPI Number | 1801165279
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Entity Type | Individual
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Provider Name | BRADLEY JOEL BAUM DDS
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Gender | Male
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 10921 WILSHIRE BLVD 804
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City | LOS ANGELES
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State | CA
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Zip | 90024-3906
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Country | US
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Telephone | 310-208-5678
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Fax | 310-208-1968
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Provider Business Mailing Address
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Address Line | 10921 WILSHIRE BLVD 804
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City | LOS ANGELES
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State | CA
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Zip | 90024-3906
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Country | US
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Telephone | 310-208-5678
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Fax | 310-208-1968
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 27953
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License Number State | CA
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