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General NPI Number Information
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NPI Number | 1003574336
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Entity Type | Organization
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Legal Business Name | 5 STAR SMILES DENTISTRY
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Dates
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Enumeration Date | 12/03/2021
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 16755 SW BASELINE RD STE 106
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City | BEAVERTON
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State | OR
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Zip | 97006-4284
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Country | US
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Telephone | 203-645-4016
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Fax |
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Provider Business Mailing Address
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Address Line | 9559 SW ANNA BELLE CT
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City | TIGARD
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State | OR
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Zip | 97223-3349
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Country | US
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Telephone | 203-500-1276
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MOUSTAPHA SY
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Credential | DDS
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Telephone | 203-500-1276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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