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Individual
JUSTIN TAN
Active
Individual
JUSTIN TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE60502542
WA
Other
Enumeration date
12/03/2014
Last updated
12/03/2014
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