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General NPI Number Information
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NPI Number | 1912066713
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Entity Type | Individual
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Provider Name | BLAIR WASHBURN FADEM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 735 E OHIO AVE STE 202
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City | ESCONDIDO
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State | CA
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Zip | 92025-3437
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Country | US
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Telephone | 760-294-7450
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Fax | 760-294-7450
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Provider Business Mailing Address
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Address Line | 735 E OHIO AVE SUITE #202
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City | ESCONDIDO
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State | CA
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Zip | 92025-3437
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Country | US
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Telephone | 760-294-7450
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Fax | 760-294-7450
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 39399
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License Number State | CA
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