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Individual

BRYAN MASON FAULK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DENTAL TECHNICIAN

Contact information

Practice address
BLDG #50 FARENHOLT AVE, AGANA HEIGHTS, GU 96910
(671) 344-9493
Mailing address
PSC 455 BOX 208, FPO, AP 96540-0003
(671) 344-9493

Taxonomy

Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary

Other

Enumeration date
02/22/2023
Last updated
02/22/2023
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