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General NPI Number Information
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NPI Number | 1982759148
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Entity Type | Organization
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Legal Business Name | CONVALESCENT DENTAL CARE
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 6226 HALF W MANCHESTER AVE
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City | LOS ANGELES
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State | CA
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Zip | 90045
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Country | US
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Telephone | 310-215-9156
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Fax |
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Provider Business Mailing Address
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Address Line | 6226 1 HALF W. MANCHESTER AVE.
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City | LOS ANGELES
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State | CA
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Zip | 90045
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Country | US
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Telephone | 310-215-9156
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | ALGIS V. LASAS
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Credential |
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Telephone | 310-215-9156
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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 | 20552
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License Number State | CA
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