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General NPI Number Information
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NPI Number | 1942437983
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Entity Type | Organization
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Legal Business Name | ASIL DENTAL GROUP, INC
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 390 CAMINO DE ESTRELLA
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4859
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Country | US
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Telephone | 949-481-2000
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Fax | 949-481-2411
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Provider Business Mailing Address
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Address Line | 390 CAMINO DE ESTRELLA
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4859
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Country | US
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Telephone | 949-481-2000
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Fax | 949-481-2411
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARINA O ASIL
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Credential |
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Telephone | 949-481-2000
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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 | 56645
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 49560
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 52200
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 52710
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License Number State | CA
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