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General NPI Number Information
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NPI Number | 1831503689
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Entity Type | Organization
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Legal Business Name | GULALAI MATIN D.D.S INC
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 4645 FRAZEE RD STE A
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City | OCEANSIDE
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State | CA
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Zip | 92057-6152
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Country | US
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Telephone | 760-722-0137
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Fax | 760-722-2696
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Provider Business Mailing Address
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Address Line | 4645 FRAZEE RD STE A
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City | OCEANSIDE
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State | CA
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Zip | 92057-6152
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Country | US
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Telephone | 760-722-0137
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Fax | 760-722-2696
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Authorized Official
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Title or Position | OWNER
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Name | MRS. GULALAI MATIN
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Credential | DDS
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Telephone | 760-722-0137
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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 | 43199
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License Number State | CA
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