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General NPI Number Information
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NPI Number | 1861947954
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Entity Type | Organization
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Legal Business Name | REGAL CARE LLC
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Dates
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Enumeration Date | 08/18/2016
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 6817 N CEDAR RD STE 202
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City | SPOKANE
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State | WA
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Zip | 99208-4277
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Country | US
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Telephone | 509-326-6862
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Fax | 509-443-4263
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Provider Business Mailing Address
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Address Line | 6817 N CEDAR RD STE 202
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City | SPOKANE
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State | WA
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Zip | 99208-4277
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Country | US
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Telephone | 509-326-6862
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Fax | 509-443-4263
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHARLES LEE REGALADO
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Credential | DDS
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Telephone | 509-326-6862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 006678
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License Number State | WA
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