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General NPI Number Information
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NPI Number | 1154656270
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Entity Type | Organization
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Legal Business Name | SMILE EIGHT PROFESSIONALS LLC
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Dates
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Enumeration Date | 10/07/2009
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Last Update Date | 10/07/2009
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Provider Practice Location Address
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Address Line | 274 W 64TH AVE
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City | LOVELAND
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State | CO
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Zip | 80538
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Country | US
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Telephone | 970-667-0446
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Fax | 970-667-4196
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Provider Business Mailing Address
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Address Line | 274 W 64 AVE
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City | LOVELAND
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State | CO
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Zip | 80538
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Country | US
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Telephone | 970-667-0446
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Fax | 970-667-4196
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Authorized Official
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Title or Position | OWNER
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Name | CARL ALBERT BAHR
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Credential | DMD
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Telephone | 970-667-0446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8757
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License Number State | CO
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