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General NPI Number Information
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NPI Number | 1114190220
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Entity Type | Organization
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Legal Business Name | ALLEN SCLAROFF DDS INC
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 1 BARNES JEWISH HOSPITAL PLZ SUITE 16432
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1003
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Country | US
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Telephone | 314-361-6006
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Fax | 314-631-6599
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Provider Business Mailing Address
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Address Line | 1040 N MASON SUITE 207
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City | CREVE COEUR
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State | MO
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Zip | 63141
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Country | US
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Telephone | 314-453-9705
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Fax | 314-453-9706
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALLEN SCLAROFF
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Credential | DDS
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Telephone | 314-453-9705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 012170
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License Number State | MO
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