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General NPI Number Information
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NPI Number | 1164879052
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Entity Type | Organization
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Legal Business Name | SMITH ENDODONTICS
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Dates
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Enumeration Date | 05/20/2016
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Last Update Date | 05/20/2016
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Provider Practice Location Address
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Address Line | 1520 BUSINESS CENTER DR SUITE 2
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City | ORANGE PARK
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State | FL
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Zip | 32003-9011
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Country | US
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Telephone | 904-637-0028
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Fax | 904-644-8230
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Provider Business Mailing Address
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Address Line | 1520 BUSINESS CENTER DR SUITE 2
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City | ORANGE PARK
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State | FL
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Zip | 32003-9011
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Country | US
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Telephone | 904-637-0028
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Fax | 904-644-8230
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL R. SMITH
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Credential | DMD
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Telephone | 904-637-0028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN13788
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License Number State | FL
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