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General NPI Number Information
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NPI Number | 1184353625
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Entity Type | Organization
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Legal Business Name | COMPASS DENTAL LLC
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 908 PENN AVE
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City | WYOMISSING
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State | PA
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Zip | 19610-3017
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Country | US
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Telephone | 608-201-2502
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Fax |
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Provider Business Mailing Address
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Address Line | 822 EVERGREEN DR
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City | WYOMISSING
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State | PA
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Zip | 19610-1518
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. AMANDA STEGEMAN SONNTAG
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Credential | DDS
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Telephone | 608-201-2502
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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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