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General NPI Number Information
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NPI Number | 1831397710
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Entity Type | Individual
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Provider Name | JOHN ALDEN COLEMAN III D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 110 ESCONDIDO AVE STE. 102
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City | VISTA
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State | CA
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Zip | 92084-6037
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Country | US
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Telephone | 760-726-0770
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Fax |
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Provider Business Mailing Address
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Address Line | 5064 SUMMERHILL DR
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City | OCEANSIDE
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State | CA
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Zip | 92057-6920
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Country | US
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Telephone | 760-842-5158
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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 | 55830
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License Number State | CA
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