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Individual
SOAN NGO
Active
Individual
SOAN NGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
18186
TX
Other
Enumeration date
06/17/2005
Last updated
07/08/2007
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