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General NPI Number Information
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NPI Number | 1023820875
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Entity Type | Organization
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Legal Business Name | SMILES DENTAL LLC
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 316 RUE SAINT FRANCOIS ST
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City | FLORISSANT
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State | MO
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Zip | 63031-5016
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Country | US
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Telephone | 314-838-1167
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Fax | 314-838-0823
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Provider Business Mailing Address
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Address Line | 316 RUE SAINT FRANCOIS ST
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City | FLORISSANT
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State | MO
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Zip | 63031-5016
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Country | US
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Telephone | 314-838-1167
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Fax | 314-838-0823
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Authorized Official
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Title or Position | DENTIST/ OWNER
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Name | DETRICH WILLIAMS
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Credential | DMD
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Telephone | 305-731-8141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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