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General NPI Number Information
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NPI Number | 1831259688
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Entity Type | Individual
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Provider Name | MANDEEP DILIP PATEL DDS
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Gender | Male
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15290-B BEAR VALLEY ROAD (AT BALSAM AVE)
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City | VICTORVILLE
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State | CA
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Zip | 92392
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Country | US
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Telephone | 760-951-7777
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Fax | 760-951-1582
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Provider Business Mailing Address
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Address Line | 10757 LEMON AVE APT 1328
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City | ALTA LOMA
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State | CA
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Zip | 91737-6948
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Country | US
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Telephone | 951-907-1710
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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 | 54188
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License Number State | CA
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