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General NPI Number Information
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NPI Number | 1215819933
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Entity Type | Organization
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Legal Business Name | SPRUCE DENTAL, LLC
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Dates
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Enumeration Date | 07/23/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 1763 TAYLOR RD STE 1
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City | PORT ORANGE
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State | FL
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Zip | 32128-6842
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Country | US
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Telephone | 386-690-6705
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Fax |
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Provider Business Mailing Address
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Address Line | 2560 S PENINSULA DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-5528
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Country | US
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Telephone | 386-295-3815
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EUGENE JOSEPH LECOMPTE
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Credential | DDS
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Telephone | 386-295-3815
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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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