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General NPI Number Information
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NPI Number | 1902073307
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Entity Type | Organization
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Legal Business Name | GUY W MENDIVIL, D.D.S. PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 3998 VISTA WAY SUITE B
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City | OCEANSIDE
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State | CA
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Zip | 92056
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Country | US
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Telephone | 760-945-1420
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Fax | 760-945-4692
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Provider Business Mailing Address
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Address Line | 3998 VISTA WAY SUITE B
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City | OCEANSIDE
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State | CA
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Zip | 92056
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Country | US
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Telephone | 760-945-1420
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Fax | 760-945-4692
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Authorized Official
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Title or Position | OWNER
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Name | MR. GUY W MENDIVIL
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Credential | DDS
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Telephone | 760-945-4692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D29737
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State | CA
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