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General NPI Number Information
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NPI Number | 1831675263
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Entity Type | Organization
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Legal Business Name | MY DENTAL L.L.C.
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 725 N CENTRAL AVE STE 109
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City | AVONDALE
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State | AZ
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Zip | 85323-1659
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Country | US
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Telephone | 623-322-4575
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Fax | 623-322-4312
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Provider Business Mailing Address
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Address Line | 2001 W BETHANY HOME RD
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City | PHOENIX
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State | AZ
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Zip | 85015-2471
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Country | US
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Telephone | 602-249-9621
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Fax | 602-841-1916
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Authorized Official
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Title or Position | DR./OWNER
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Name | DR. YOUIL G. MAMOOK
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Credential | D.D.S.
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Telephone | 480-388-7049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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