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General NPI Number Information
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NPI Number | 1902013683
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Entity Type | Organization
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Legal Business Name | NEWPORT CENTER DENTAL GROUP
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1401 AVOCADO AVE SUITE 404
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7720
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Country | US
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Telephone | 949-640-1122
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Fax | 949-640-0929
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Provider Business Mailing Address
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Address Line | 1401 AVOCADO AVE SUITE 404
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7720
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Country | US
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Telephone | 949-640-1122
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Fax | 949-640-0929
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. DAN J SPEARS
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Credential | DDS
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Telephone | 949-640-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 37165
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License Number State | CA
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