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General NPI Number Information
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NPI Number | 1841639077
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Entity Type | Organization
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Legal Business Name | PACKER ENDODONTICS
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Dates
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Enumeration Date | 06/20/2013
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 26671 ALISO CREEK RD STE 300
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City | ALISO VIEJO
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State | CA
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Zip | 92656-4810
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Country | US
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Telephone | 949-572-4078
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Fax | 708-443-8410
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Provider Business Mailing Address
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Address Line | 26671 ALISO CREEK RD STE 300
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City | ALISO VIEJO
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State | CA
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Zip | 92656-4810
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Country | US
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Telephone | 949-572-4078
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Fax | 708-443-8410
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH L PACKER
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Credential | DMD, MSD
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Telephone | 949-572-4078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 58887
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License Number State | CA
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