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General NPI Number Information
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NPI Number | 1932650249
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Entity Type | Organization
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Legal Business Name | MARIA TERESA R DE GUZMAN DDS CORP
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 5060 SUNRISE BLVD SUITE A1
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City | FAIR OAKS
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State | CA
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Zip | 95628-4944
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Country | US
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Telephone | 916-863-0456
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Fax | 916-910-0751
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Provider Business Mailing Address
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Address Line | 5060 SUNRISE BLVD STE A4
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City | FAIR OAKS
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State | CA
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Zip | 95628-4944
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Country | US
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Telephone | 916-910-0708
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Fax | 916-910-0751
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ANTHONY E DEGUZMAN
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Credential |
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Telephone | 916-919-5721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 41390
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 41390
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License Number State | CA
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