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General NPI Number Information
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NPI Number | 1871883389
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Entity Type | Individual
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Provider Name | ELISA MEZA DDS
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Gender | Female
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | BENITO JUAREZ (CALLE 2DA) 1844-1 ZONA CENTRO
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City | TIJUANA
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State | BAJA CALIFORNIA
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Zip | 22000
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Country | MX
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Telephone | 664-685-8632
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Fax | 664-685-8632
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Provider Business Mailing Address
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Address Line | 416 W SAN YSIDRO BLVD STE 1416
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City | SAN DIEGO
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State | CA
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Zip | 92173-2443
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Country | US
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Telephone | 619-488-4010
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Fax | 619-559-0744
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 4964081
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License Number State | ZZ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4316145
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License Number State | ZZ
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14724
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License Number State | ZZ
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Taxonomy #4
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 16057
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License Number State | ZZ
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