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General NPI Number Information
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NPI Number | 1174073670
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Entity Type | Organization
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Legal Business Name | TRUSTED SMILES DENTAL CARE
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 959 HARRISON AVE
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City | COLUMBUS
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State | OH
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Zip | 43201-3324
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Country | US
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Telephone | 614-428-0487
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Fax | 614-568-1808
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Provider Business Mailing Address
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Address Line | 959 HARRISON AVE
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City | COLUMBUS
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State | OH
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Zip | 43201-3324
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Country | US
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Telephone | 614-428-0487
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Fax | 614-568-1808
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Authorized Official
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Title or Position | MANAGING PARTNER/OWNER
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Name | DR. JEFF KOVER
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Credential | D.D.S.
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Telephone | 614-428-0487
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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 | 30020433
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License Number State | OH
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